Presentation (CTI)

OBJECTIVES: Peritoneal dialysis (PD) and home haemodialysis (HHD) may reduce reliance on in-centre haemodialysis (ICHD) and generate savings for the UK National Health Service (NHS), with PD comprising the majority of home dialysis modalities. The Getting It Right First Time (GIRFT) programme recommends a 20% minimum target for prevalent dialysis patients receiving home dialysis, while the Welsh Kidney Network has set a 30% target. This study estimated the five-year budget impact of reaching 20% versus 30% home dialysis.
METHODS: A budget impact model was developed from the UK NHS perspective over five years. The current UK modality distribution was compared with two scenarios in which home dialysis targets were reached by Year 5. In the GIRFT-aligned scenario, PD and HHD uptake increased at the same annual rate so that 20% of patients received home dialysis in Year 5. In the Wales-informed scenario, the same approach was applied to achieve 30% home dialysis in Year 5. Increased home dialysis uptake was offset by reductions in in-centre and satellite ICHD distributions. Costs per dialysis modality were informed by a Welsh micro-costing study. Outputs included annual and cumulative budget impact of the GIRFT and Wales-informed scenarios versus current practice and the incremental savings of increasing from 20 to 30% on home dialysis in Year 5.
RESULTS: Compared with the GIRFT-aligned 20% home dialysis scenario, the Wales-informed 30% scenario generated an additional £204.3 million in cumulative NHS savings over five years. This represented approximately 3.5 times the cumulative savings achieved under the 20% scenario, with total savings versus current practice increasing from £81.7 million to £286.0 million.
CONCLUSIONS: Moving from a 20% to a 30% home dialysis benchmark could substantially increase projected NHS savings, with PD accounting for most home dialysis uptake. These findings support the expansion of clinically appropriate home dialysis provision.