Missing facts, different countries

Blaggs states that home haemodialysis (HD) is cost effective.¹ In the United States, where there is less likelihood of receiving a cadaveric transplant than in the United Kingdom (45% v 30%), the economics are different. In the United Kingdom the break even point on the set up and running costs of home HD v in-centre HD is about two years. Analysis of data from the UK Renal Registry shows that within 20 months of starting, half of the patients receiving home HD would have received a kidney transplant. This makes the cost neutral point towards 3-4 years.

It will always be difficult to show that home HD improves survival as patients on the home HD programme in any renal unit are always highly selected. They are unlikely to have any comorbid conditions and have good fistulas (not central lines). It is difficult even with age matching to allow for all these selection factors in matching a similar cohort.

Short daily dialysis is a separate (and more costly) entity than standard home HD requiring specific equipment and is currently undergoing evaluation in the UK.

The high rates of home HD in New Zealand are related to some specific factors in their healthcare system but do not imply a free choice. The UK also has a larger peritoneal dialysis programme than the US and other EU countries. In those countries some patients receiving home HD may rather have chosen peritoneal dialysis. All these factors increase the complexity of any international comparison.