Transplantation and home hemodialysis: their cost-effectiveness

Transplantation and home hemodialysis treatments have been available to treat patients with end stage renal disease for several years but it is not clear which approach is most cost-effective. This study compared the costs of hemodialysis and transplantation for comparable patients using the marginal cost methodology. Sixteen patients in a home program were matched with 16 patients in a transplantation program for sex, age, primary disease and other medical diseases. Questionnaires and a chart review allowed the accounting of all health services received in hospitals, offices or at home, and provided indicators of treatment effectiveness. The impact of the additional services generated by choosing one treatment over the other (difference between the two programs) was evaluated in terms of personnel, equipment and supplies. Survival and rehabilitation were similar in the two groups. However, for each year of follow-up, transplantation was considerably less expensive than home dialysis. These results suggest that transplantation is the most cost-effective way to treat end stage renal failure, at least for the subgroup of patients equally eligible for either transplantation or home dialysis.