Throughout the EU, Member States are looking for ways to provide patient-centred care to maximize clinical outcomes and improve cost-effectiveness for healthcare systems. For many countries, this means re-organisation of how care is delivered and in some cases general cost-cutting to sustain the system. So, when policymakers are faced with difficult decisions about how to maintain quality of care within a resource constrained system why is it that they should care about dialysis?
Giving patients a choice
The fact is that dialysis is necessary for many thousands of patients, but is responsible for a significant proportion of healthcare resources. In Europe it is estimated that more than 5% of the adult population have a varying degree of kidney damage and furthermore every year European healthcare systems spend between €40,000 – €80,000 per patient on dialysis (depending on country).
Yet, with the right structures in place, dialysis services can be organized in an integrated way including home dialysis which can improve cost-efficiency while providing a high quality of care for patients. Giving patients a choice over the modality of dialysis is at the heart of this integrated dialysis system and should include easy access to kidney transplantation for those that are suitable.
Currently, most dialysis patients in Europe (90%) must travel to a hospital or similar healthcare centre in order to receive haemodialysis. Only a minority of patients receive home dialysis (peritoneal dialysis or home haemodialysis) – but there is inequity of provision, the proportion receiving home dialysis varies across Europe from under 5% to over 30%.
The frequency of in centre haemodialyis treatment is fixed at 3, and tends to be costly for the system and can be a burden on the patient as the patients spend 5-7 hours per day three times a week and may need up to 7 hours recovery time. Not surprisingly, studies have shown that given the choice, 35 – 55% of patients would prefer to be treated at home. And, home dialysis treatment has been shown to be more cost-effective compared to in centre haemodialysis. 
Doing more at home
The problem is, most patients don’t have access to at-home dialysis treatment because healthcare systems are encouraging in-centre dialysis treatments and take little regard to patient preference, and overall cost-effectiveness of an integrated dialysis service which includes home based therapies.
This is an issue that policymakers can help resolve, particularly as Member States evaluate their health systems in the context of the European Semester. Many of the country specific recommendations provided by the European Commission on healthcare look specifically at addressing over reliance on hospital care and over-use of the in-patient sector.
Thinking ahead for a better future
By implementing more flexible and patient-centred reimbursement structures for the different dialysis treatments, health systems can provide both evidence based and cost-effective treatment to chronic kidney disease patients.
For example, cost estimates for the United Kingdom show that increasing the use of home dialysis from the current 20% over a 5 year period (2% increase per year), would generate cumulative savings of GBP 343 million.
With an ageing population and an increasing incidence of diabetes, hypertension and heart disease (all major causes of chronic kidney disease), health systems will continue to see the costs rise for dialysis treatment.
While home dialysis alone will not solve the difficulties faced by health authorities, it is an area where widening access for patients could result in significant benefits to patients as well as all health stakeholders.
Click here for more information about dialysis treatment and reimbursement in community care.
– Dr Peter Rutherford, Baxter-Gambro Renal, Medical Director, EMEA
 European Kidney Health Alliance. The Alarming Rise in Chronic Kidney Disease in Europe: How to deal with a costly problem. http://www.era-edta.org/images/2013_EKHA_Call_to_Action_ANNEX_2%20.pdf
 Lindsay R et al. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin J Am Soc Nephrol 2006;1(5):952–9.
 Jager KJ, Korevaar JC, Dekker FW et al. The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in The Netherlands. Am J Kidney Dis 2004; 43: 891-899
 Just PM et al., Health Policy 2008; 86:163-180
 Joble J, Laplante S. Impact of home dialysis on UK healthcare budget. 2010 Annual meeting of the European Renal Association – European Dialysis and Transplant Association. Munich, Germany, June 2010 (poster).