The economics of daily dialysis

Research suggests that daily hemodialysis improves clinical outcomes and patient quality of life when compared with conventional hemodialysis; however, little is known about its economic impact. In this article, we review the literature on the costs of daily hemodialysis (n = 170). We also present updated results from an economic model we constructed that compares 1-year treatment costs for short daily in-center, short daily at-home, nocturnal, and conventional hemodialysis. Clinical parameters for the model were drawn from our review of the clinical literature. Resource use during daily hemodialysis was modeled after the experience of 2 ongoing programs in the United States, a short daily program in California (n = 26) and a nocturnal program in Virginia (n = 13). Reports from the literature and our economic model suggest daily hemodialysis might provide better outcomes and savings when compared with conventional hemodialysis. However, larger, longer controlled studies are needed to see if daily dialysis fulfills these promises. We discuss several issues researchers should keep in mind in designing future studies about the economics of daily dialysis.