PATIENT PREFERENCES FOR DIALYSIS MODALITIES: A DISCRETE-CHOICE EXPERIMENT

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.

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The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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