Feasibility of Home Hemodialysis for Colombia: A Cost-Effectiveness Perspective

Area of Science:

• Health Economics
• Nephrology
• Public Health Policy

Background:

• End-stage renal disease (ESRD) management often involves hemodialysis (HD).
• Home hemodialysis (HHD) offers an alternative to in-center HD, particularly for patients with contraindications or failure of peritoneal dialysis.
• Assessing the economic implications of HHD versus traditional HD is crucial for healthcare resource allocation.

Purpose of the Study:

• To evaluate the incremental cost-utility ratio (ICUR) of HHD compared to in-center HD in Colombia.
• To analyze cost-effectiveness from both healthcare system (payer) and societal perspectives.
• To inform health policy decisions regarding ESRD treatment modalities in Latin America.

Main Methods:

• A 5-year Markov model was utilized for cost-utility analysis.
• Quality-adjusted life-years (QALYs) and ICERs were primary outcomes.
• Data on direct medical costs (microcosting) and indirect costs (patient surveys) were collected and converted to USD.

Main Results:

• From the payer perspective, HHD incurred additional costs of USD 25,928 and yielded 0.31 QALYs, resulting in an ICER of USD 82,674 per QALY, exceeding Colombia's cost-effectiveness threshold.
• From the societal perspective, including indirect costs significantly improved HHD's cost-effectiveness, indicating potential economic viability.
• Sensitivity analyses were performed using Monte Carlo simulations.

Conclusions:

• HHD is not cost-effective from a third-party payer viewpoint in Colombia.
• When indirect costs and out-of-pocket expenses are considered, HHD emerges as a viable treatment alternative.
• This study underscores the importance of comprehensive economic assessments, beyond direct medical costs, for health policy formulation in Latin America.