Preference for Alternate-Day Versus Conventional In-Center Dialysis: A Health Utility Elicitation

BACKGROUND: Mortality rates for patients on hemodialysis (HD) continue to be high, in particular, following the long interdialytic period, yet thrice-weekly conventional HD (CHD) is still an almost universal regimen. Alternate-day dialysis (ADD) may have advantages over the current schedule because it would eliminate the long interdialytic break. A preliminary, as yet unpublished, patient simulation and cost-utility analysis compared CHD versus ADD and demonstrated that the economic attractiveness of ADD was sensitive, in particular, to patients’ preference for ADD versus CHD. To date, this preference has not been elicited. OBJECTIVE: To elicit utilities for both CHD and ADD using 3 standard elicitation methods among a prevalent cohort of patients on CHD. DESIGN: This study is a single-center survey of patient preferences (utilities). SETTING: This study took place within the dialysis units of Sunnybrook Health Centre, a university-affiliated teaching hospital in Toronto, Ontario, Canada, which encompasses 174 patients on in-center HD. PATIENTS: Those older than 18 years of age, on thrice-weekly HD, were included in this study. MEASUREMENTS: Descriptive statistics were used to summarize patient characteristics and the utility values generated. A multiple linear regression was performed to determine an association between participant characteristics and the utility ratio. METHODS: Via standardized face-to-face interviews by a single investigator, 3 utility elicitation methods, visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG), were administered to generate utilities for each patient for their current health state of CHD (thrice-weekly). After completing this task, we provided each patient with a concise summary regarding the current literature on how ADD may impact their health. Finally, patients were asked to envision their health while on an ADD regimen while repeating the VAS, TTO, and SG. RESULTS: We recruited 65 participants. The mean utilities of CHD versus ADD were similar for all 3 methods. Visual analogue scale, TTO, and SG had utility values of 0.6 ± 0.2, 0.6 ± 0.3, and 0.7 ± 0.3, and 0.6 ± 0.2, 0.7 ± 0.3, and 0.7 ± 0.3 for CHD and ADD, respectively. The ratio for CHD to ADD was 1.1 ± 0.4, 1.1 ± 0.5, and 1.0 ± 0.2 for VAS, TTO, and SG, respectively. LIMITATIONS: Small sample size from a single center, where not all participants agreed to participate, wide variability in participant responses and requiring patients to conceptually imagine life on ADD may have affected our results. CONCLUSIONS: Compared with CHD, there was no difference in the preference toward ADD which demonstrates promise that adopting an alternate-day schedule may be acceptable to patients. Furthermore, with the generation of a utility for ADD, this will allow for more precise estimates in future simulation studies of the economic attractiveness of ADD. TRIAL REGISTRATION: Not required as this article is not a systematic review nor does it report the results of a health care intervention.