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Abstract: FR-PO509

Simulating Strategies to Launch a Home Therapies Program in a Conventional Hemodialysis Facility

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis


  • 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

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.


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%.


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%.


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 conversionIncident modality mixPD (%)
in 2027
HHD (%)
in 2027
Mean annual revenue ($ millions)
during 2023-2027
Current State14.5% PD, 0.5% HHD7.5 (7.5)5.3 (4.6)4.97 (4.95)
 20% PD, 5% HHD10.2 (10.2)7.5 (6.7)4.98 (4.99)
 20% PD, 20% HHD10.5 (10.2)15.1 (12.9)5.10 (5.10)
3x Higher Rate14.5% PD, 0.5% HHD7.3 (7.4)14.5 (12.8)5.07 (5.05)
 20% PD, 5% HHD10.3 (10.2)16.4 (14.2)5.12 (5.07)
 20% PD, 20% HHD10.1 (10.0)23.3 (20.5)5.22 (5.18)
5x Higher Rate14.5% PD, 0.5% HHD7.5 (7.3)22.5 (20.0)5.20 (5.17)
 20% PD, 5% HHD10.1 (10.2)23.9 (20.9)5.22 (5.22)
 20% PD, 20% HHD10.3 (10.1)30.2 (26.7)5.34 (5.27)

Each cell displays the statistic with (without) use of an innovative HHD device.