Home Dialysis Comes Out Cheaper Than In-Centre Care in UK Micro-Costing Study
A detailed micro-costing analysis from a UK renal centre has put hard numbers on a question dialysis services wrestle with every year: how much does each modality truly cost when workforce, consumables, utilities, maintenance, administration, and overheads are counted in full? The answer is not uniform across dialysis pathways, and the spread is wide enough to affect service planning, staffing design, and reimbursement discussions.
Across the 2023–24 financial year, in-centre haemodialysis remained the largest part of the service by volume, with 45,157 sessions delivered. Satellite haemodialysis contributed another 5,326 sessions, while 31,737 peritoneal dialysis treatment days were delivered. In the provider-cost analysis, annual per-patient treatment costs were £25,598 for in-centre haemodialysis, £26,678 for satellite haemodialysis, £16,573 for continuous ambulatory peritoneal dialysis, £36,859 for continuous cyclic peritoneal dialysis, £41,085 for assisted automated peritoneal dialysis, and £18,320, £24,427, and £30,534 for home haemodialysis delivered three, four, and five times weekly, respectively.
CAPD and three-times-weekly home haemodialysis carried the lowest annual provider costs.
Why the Cost Stack Looks Different Across Modalities
The size of the difference is best understood by looking at what drives the bill. Hemodialysis in a staffed unit consumes time from consultants, resident doctors, nurses, maintenance staff, and administrators, in addition to consumables, water treatment, equipment support, and infection-control-related costs. The model also incorporated the cost of utility bills for patients receiving home therapies, maintenance of the renal electronic patient record, capitation fees paid to the UK Renal Registry, and overhead allocations. For peritoneal dialysis, the costing pathway relied on supplier invoices and modality-specific cross-checking against account codes.
In practice, the modality itself shapes the cost structure. In-centre haemodialysis requires repeated use of a tightly controlled facility, while home haemodialysis shifts part of the operational burden away from the hospital estate. Peritoneal dialysis alters the balance again by reducing dependence on in-unit staff and infrastructure, although the automated and assisted forms can still become expensive when equipment, support, and logistics accumulate. The study design captured those distinctions by tracing expenditure back to cost centres and account codes rather than relying on broad averages.
Benchmark Margins Favoured Some Home Pathways
The analysis did more than calculate provider costs. It compared those estimates with the 2023–24 NHS Best Practice Tariff values adjusted for Market Forces Factor, using that tariff as a standardized benchmark rather than a direct cash reimbursement figure. Under that framework, three-times-weekly and four-times-weekly home haemodialysis produced positive benchmark margins, while five-times-weekly home haemodialysis produced a small negative benchmark margin.
Frequency mattered. Three-times-weekly home haemodialysis was the least expensive of the home haemodialysis schedules studied, at £18,320 annually per patient, while five-times-weekly treatment rose to £30,534. The pattern is clinically intuitive: as frequency increases, equipment use, consumables, and operational burden rise, and the economy of the home setting begins to erode. The analysis explicitly tested that assumption in sensitivity work by examining how alternative equipment-cost allocations would affect the result.
Peritoneal Dialysis Split into Clear Cost Tiers
Peritoneal dialysis did not behave as a single cost category. Continuous ambulatory peritoneal dialysis came in at £16,573 annually per patient, placing it among the least expensive modalities overall. Continuous cyclic peritoneal dialysis cost £36,859, and assisted automated peritoneal dialysis was higher still at £41,085.
Those differences matter because they reflect distinct clinical and operational realities rather than mere accounting noise. CAPD depends on a manual exchange regimen that can be less infrastructure-intensive, while automated and assisted forms require cyclers, support, and more complicated delivery arrangements. A cost model that treats all peritoneal dialysis as interchangeable would miss those distinctions entirely, and that would distort planning for programs trying to expand home therapy capacity or redesign staffing around community-based care.
The Costing Method Was Built to Be Reproducible
The strength of this work lies in method rather than novelty of concept. Investigators used detailed financial, workforce, consumable, and activity data from University Hospitals of Derby and Burton NHS Foundation Trust during the 2023–24 financial year, combining Trust financial ledgers, consultant job plans, workforce activity mapping, consumable expenditure, maintenance costs, administration, and overheads. A local overhead uplift of 30% was applied to haemodialysis delivered at Royal Derby Hospital and 15% to community, satellite, and home therapies. Those rates were local costing assumptions rather than nationally mandated NHS overhead rates.
This matters because overhead allocation can quietly dominate the final result. If institutional uplifts are too blunt, they can make one modality appear more or less expensive for reasons unrelated to actual resource use. To examine that possibility, the analysis included sensitivity testing with common overhead rates of 0%, 15%, and 30% applied across modalities, as well as an alternative home haemodialysis scenario in which equipment costs rose with treatment frequency while other non-equipment program costs were held constant. The base conclusion remained centered on the same point: home haemodialysis and CAPD were among the lower-cost options, while the automated peritoneal modalities were costlier.
Service Planning Now Has a More Concrete Financial Map
For renal services under pressure to expand home therapy use, the practical implication is straightforward. A program that shifts more suitable patients toward CAPD or lower-frequency home haemodialysis may reduce provider expenditure while also diversifying care away from heavily staffed in-centre sessions. That does not make one modality universally preferable for every patient, because modality choice is still governed by vascular access, peritoneal membrane suitability, social support, infection risk, and patient preference. Even so, the economic profile now has a clearer shape.
The burden of dialysis in the UK remains substantial, with more than 31,000 people receiving dialysis in 2023 and the national cost estimated at more than £1.05 billion annually, before transport costs are added. Within that context, the move from broad estimates to pathway-level costing is not an academic refinement. It is the kind of information that can shape capital planning, workforce allocation, and decisions about where to build capacity.
What This Study Can and Cannot Prove
This is a single-centre analysis, so the results reflect a specific operational setting, local costing assumptions, and one Trust’s service structure during one financial year. The benchmark comparison used NHS Best Practice Tariff values adjusted for Market Forces Factor, but those figures functioned as standardized reference points rather than a statement about actual reimbursement received by the Trust. The study also relied on allocation methods for staff time and overheads that, while carefully constructed, still depend on local accounting assumptions.
Even with those limits, the study provides something many renal services lack: a reproducible framework for tracing real-world dialysis costs from the ledger to the bedside. The result is a more exact view of where money is spent, which modalities absorb the most institutional resources, and how home-based pathways compare when the full operational footprint is counted.
The remaining question is not whether dialysis costs differ by modality. They clearly do. The more urgent question is how many services can reconfigure care around home pathways without running into staffing, training, and infrastructure constraints that were never built for that shift in the first place.