K SHAH1, F MURTAGH2, K MCGEECHAN3, S CRAIL4, A BURNS5, A TRAN1, RL MORTON1
1NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia, 2Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom, 3School of Public Health, University of Sydney, Camperdown, Australia, 4Royal Adelaide Hospital, Adelaide, Australia, 5Royal Free Hospital, London NHS Foundation Trust, Hampstead, United Kingdom
Aim: To compare health-related quality of life (HR-QOL) in those over 75-years managed with comprehensive conservative care or dialysis; and evaluate associations between HR-QOL and socio-demographic characteristics.
Background: Older people with end-stage kidney disease (ESKD) and their clinicians need information about likely HR-QOL with comprehensive conservative care or dialysis to inform treatment decisions.
Methods: Prospective cross-sectional study of HR-QOL in older people treated at Australian and UK renal units offering comprehensive conservative care and dialysis programs. HR-QOL was measured with the ShortForm-12 (SF-12) questionnaire and transformed into quality-adjusted survival (QALY) weights, known as utilities, using the SF-6D algorithm. Mean utilities on a 0-1 scale (0=death, 1=full health) and standard deviations were estimated using Australian and UK population values. Determinants of increased/decreased utility were investigated using univariate and multivariate linear regression models.
Results: Of 129 patients from 3 renal units, mean age 82 years [IQR 78-85], 65% males, 46 (36%) were managed with comprehensive conservative care and 83 (64%) managed with dialysis. The mean utility for 123 patients with complete data was 0.651 (SD=0.151) for comprehensive conservative care and 0.605 (SD 0.132) for dialysis. In multivariate analysis, utility was 0.084 lower for females compared with males (p=0.001); 0.060 lower for those without private health insurance compared to those with private health insurance (p=0.04) and 0.058 lower for those in the dialysis group versus comprehensive conservative care group (p=0.029). In each treatment group, the ‘social’ and ‘vitality’ domains of HR-QOL incurred the greatest decrement.
Conclusions: HR-QOL in this population of older people is estimated at around 60% to 65% of full health. For people over 75-years, comprehensive conservative care may offer quality of life benefits over dialysis.
Karan Shah is a Health Economist at NHMRC Clinical Trials Centre, University of Sydney. Prior to his full-time role as a Health Economist, he pursued Masters of Science in Health Economics at Heidelberg University in Germany. He has research interest in methodological development in estimating quality of life, within trial health economic models, quantitative research methods: systematic reviews, meta-analysis, statistical analysis, assessment of test evaluation and monitoring.