A discrete choice study of patient preferences for dialysis modalities

Abstract

Background and objectives Improved knowledge about factors that influence patient choices when considering dialysis modality could facilitate health care interventions to increase rates of home dialysis. We aimed to quantify the attributes of dialysis care and the tradeoffs that patients consider when making decisions about dialysis modalities. Design, setting, participants, & measurements We conducted a prospective, discrete choice experiment survey with random parameter log it analysis to quantify preferences and tradeoffs for attributes of dialysis treatment in 143 adult patients with CKD expected to require RRT within 12 months (predialysis). The attributes included schedule flexibility, patient out of pocket costs, subsidized transport services, level of nursing support, life expectancy, dialysis training time, wellbeing on dialysis, and dialysis schedule (frequency and duration). We reported outcomes using b-coefficients with corresponding odds ratios and 95%confidence intervals for choosing home-based dialysis (peritoneal dialysis or hemo dialysis) compared with facility hemodialysis. Results Home-based therapies were significantly preferred with the following attributes: longer survival (odds ratio per year, 1.63; 95% confidence interval, 1.25 to 2.12), increased treatment flexibility (odds ratio, 9.22; 95% confidence interval, 2.71 to 31.3), improved wellbeing (odds ratio, 210; 95% confidence interval, 15 to 2489), and more nursing support (odds ratio, 87.3; 95%confidence interval, 3.8 to 2014). Respondents were willing to accept additional out of pocket costs of approximatelyNewZealand*400 (United States *271)per month(95%confidence interval, New Zealand *333 to *465) to receive increased nursing support. Patients were willing to accept out of pocket costs of New Zealand *223 (United States *151) per month (95%confidence interval, New Zealand *195 to *251) for more treatment flexibility. Conclusions Patients preferred home dialysis over facility-based care when increased nursing support was available and when longer survival, wellbeing, and flexibility were expected. Socio demographics, such as age, ethnicity, and income, influenced patient choice.