Abstract: FR-PO509
Simulating Strategies to Launch a Home Therapies Program in a Conventional Hemodialysis Facility
Session Information
- Home Dialysis, Policy, Novel Approaches
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
- Dunning, Stephan C., Outset Medical, San Jose, California, United States
- Saffer, Tonya, Outset Medical, San Jose, California, United States
- Aragon, Michael A., Outset Medical, San Jose, California, United States
Background
Over half of dialysis facilities in the United States either do not offer home dialysis or have no active patients (pts) on home dialysis. Launching a home therapies program from this base leads to questions about patient selection, modality mix, device utilization, and financial impact. We designed a Markov chain Monte Carlo simulation to explore 5-year clinical and economic outcomes in a conventional hemodialysis (CHD) facility that pursues various strategies for growing home dialysis.
Methods
We simulated modality mix and total revenue in a 100-patient CHD facility in December 2022 and an average of two new patients per month during 2023-2027. We modulated three parameters: (1) prevalent patient conversion from CHD to home hemodialysis (HHD); (2) incident patient adoption of peritoneal dialysis (PD) and HHD; and (3) HHD device utilization, using an innovative HHD device that reduces HHD training attrition and the rate of conversion from HHD to CHD by 40%.
Results
Under current conditions, the launch of a home therapies program results in home penetration of 12.1% by 2027. Focusing only on increasing home dialysis adoption among incident patients increases penetration to 23.1%, while maintaining that focus and increasing conversion from CHD to HHD increases penetration to 36.8%. Reducing HHD attrition with an innovative device increases HHD utilization by 1.5 to 3.5 percentage points in most scenarios, and increases cumulative revenue per HHD start by 10% to 16%.
Conclusion
In a CHD facility, growth of home dialysis requires sustained focus on both incident and prevalent dialysis patients. Utilization of innovative devices, like the Tablo® Hemodialysis System, that improve HHD retention can accelerate home dialysis growth and positively impact facility revenue.
| CHD-to-HHD conversion | Incident modality mix | PD (%) in 2027 | HHD (%) in 2027 | Mean annual revenue ($ millions) during 2023-2027 |
| Current State | 14.5% PD, 0.5% HHD | 7.5 (7.5) | 5.3 (4.6) | 4.97 (4.95) |
| 20% PD, 5% HHD | 10.2 (10.2) | 7.5 (6.7) | 4.98 (4.99) | |
| 20% PD, 20% HHD | 10.5 (10.2) | 15.1 (12.9) | 5.10 (5.10) | |
| 3x Higher Rate | 14.5% PD, 0.5% HHD | 7.3 (7.4) | 14.5 (12.8) | 5.07 (5.05) |
| 20% PD, 5% HHD | 10.3 (10.2) | 16.4 (14.2) | 5.12 (5.07) | |
| 20% PD, 20% HHD | 10.1 (10.0) | 23.3 (20.5) | 5.22 (5.18) | |
| 5x Higher Rate | 14.5% PD, 0.5% HHD | 7.5 (7.3) | 22.5 (20.0) | 5.20 (5.17) |
| 20% PD, 5% HHD | 10.1 (10.2) | 23.9 (20.9) | 5.22 (5.22) | |
| 20% PD, 20% HHD | 10.3 (10.1) | 30.2 (26.7) | 5.34 (5.27) |
Each cell displays the statistic with (without) use of an innovative HHD device.