R WALKER1,2, R MORTON3, S PALMER4,5, M MARSHALL6, A TONG1, K HOWARD1
1Sydney School of Public Health, The University of Sydney, Australia; 2Hawke’s Bay District Health Board, Hawke’s Bay, New Zealand; 3NHMRC Clinical Trials Centre, University of Sydney, Sydney; 4Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand; 5Department of Medicine, University of Otago Christchurch, 8140, New Zealand; 6Baxter Healthcare, (Asia- Pacific), Shanghai, China.
Aim: To quantify the attributes of dialysis care and the trade-offs that patients consider when making decisions about dialysis modalities.
Background: Improved knowledge about factors that influence patient choice when considering dialysis modalities could inform healthcare interventions that increase rates of home dialysis.
Methods: We conducted a prospective, labelled, discrete choice experiment survey with random parameter logit analysis to quantify preferences and trade-offs for attributes of dialysis treatment including; schedule flexibility, patient out-of-pocket costs, subsidized transport services, level of nursing support, life expectancy, dialysis training time, well-being on dialysis, and dialysis schedule (frequency and duration). We reported outcomes using β coefficients with corresponding odds ratios and 95% confidence intervals for choosing home-based dialysis (peritoneal dialysis or haemodialysis) compared to facility haemodialysis.
Results: Home-based therapies were preferred with the following attributes: survival (OR per year increase 1.63, CI 1.25-2.12); increased treatment flexibility (OR 9.22, CI 2.71-31.3); improved well-being (OR 210, CI 15.0-2489), and more nursing support (OR 87.3, CI 3.78-2014). Respondents were willing to accept additional costs of NZ$400 (95% CI, $333-465) to receive increased nursing support. Patients were willing to accept costs of NZ$223 per month (95% CI, $195-251) for greater treatment flexibility. Socio-demographics such as age, ethnicity and household income influenced patient choice.
Conclusions: Patients preferred home dialysis over facility-based care when increased nursing support was available, and when improved survival, well-being and treatment flexibility were expected. Models of care that increase attributes associated with greater acceptability of home dialysis may support patients to choose home dialysis.