Authors' objectives:

This review aims to assess the effectiveness and cost-effectiveness of home haemodialysis, compared with haemodialysis carried out in a hospital or satellite unit, for people with end-stage renal failure.

Authors' results and conclusions: People dialysed at home generally experienced a better quality of life. There was a suggestion, however, that their partners tended to be less satisfied, both with the home setting for haemodialysis and with the increased dependency placed on them. Compared with hospital haemodialysis, patients on home haemodialysis were hospitalised less, tended to live longer, were more likely to be in full-time work and experienced fewer adverse events during haemodialysis. The one study giving details of technique survival (the time that a person remains on a particular form of RRT) suggested that patients dialysed in satellite units achieved a longer median technique survival time than those on home haemodialysis. For some outcomes, a number of studies reported statistically significant differences in favour of home haemodialysis; for other outcomes, differences were more modest but generally still favoured home haemodialysis. People undergoing home haemodialysis, however, are a highly selected group; they tend to be younger and have fewer co-morbidities than those being dialysed in hospital or satellite units. Because of these differences and the opportunities for longer and more frequent haemodialysis sessions in the home than would normally be available in hospital or satellite units, it is difficult to provide an accurate estimate of the relative effectiveness of home haemodialysis.

Authors' recommendations: Home haemodialysis has tended to be used on a highly selected group of relatively young patients with low co-morbidity. This review shows that it is generally more effective than hospital haemodialysis on a range of outcomes, and modestly more effectivethan satellite haemodialysis. It is unclear to what extent these findings are influenced by selection bias. The evidence is in favour of lower total annual costs for home haemodialysis compared with hospital haemodialysis, with treatment costs of satellite haemodialysis lower than hospital haemodialysis but higher than home haemodialysis. Expanding home and satellite haemodialysis services may provide a method of coping with increasing numbers of people requiring RRT, with less additional resources required than would otherwise be needed to expand hospital haemodialysis services. While the expansion of home haemodialysis may improve the well-being and financial security of patients, it may add considerably to the stress on carers and families. The net effect on a family's income is uncertain because it depends upon what, if any, paid employment would be given up by the carer. The expansion of home haemodialysis programmes may be difficult to achieve without recruiting and training additional nurses. Under-supported programmes may not realise the same level of benefits as those programmes identified from the literature.

Authors' methods: Systematic review, Economic evaluation

Project Status: Completed

URL for project: http://www.hta.ac.uk/1294

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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