Preferences for Anaemia Treatment Attributes among Patients with Non-Dialysis-Dependent Chronic Kidney Disease

Abstract

Introduction: Information about patient preferences for the treatment of anaemia associated with chronic kidney disease (CKD) is scarce. Hence, our aim was to examine how patients with non-dialysis-dependent CKD valued attributes of alternative hypothetical anaemia treatments. Methods: A discrete choice experiment (DCE) was conducted in adult patients who reported a clinical diagnosis of CKD-related anaemia. Treatment attributes included mode and frequency of administration, need for iron supplementation, risk of gastrointestinal side effects, risk of major cardiovascular events and impact on energy levels (as defined by the vitality section of the SF-6D health index). Logit models were used to analyse patients' preferences. Results: The DCE was completed by 200 patients in four countries. Patients preferred an oral mode of administration. Patients were willing to tolerate a 5.1% (95% CI 2.0-8.3%) increase in the risk of a major cardiovascular event and an 11.7% (95% CI 5.0-18.5%) increase in the risk of gastrointestinal side effects to switch from an at-home subcutaneous injection administered once every 2 weeks to an at-home oral pill administered three times a week. Patients were willing to tolerate a 20.3% (95% CI 15.0-25.6%) increase in the risk of gastrointestinal side effects and an 8.9% (95% CI 6.1-11.7%) increase in the risk of a major cardiovascular event to transition from 'Sometimes having a lot of energy' to 'Always having a lot of energy'. Conclusions: Patients with non-dialysis-dependent CKD-related anaemia demonstrated clear treatment preferences and were willing to accept increased gastrointestinal or cardiovascular risks in exchange for more energy or an oral treatment.

ANEMIA EN PACIENTES CON ENFERMEDAD RENAL CRÓNICA. Impacto asistencial y económico.

“…La mayoría de los pacientes con ERC y anemia prefirieron el modo de administración oral (48)(49)(50) , debido a la comodidad de la administración y para evitar el dolor de la inyección y los requisitos de almacenamiento del fármaco asociados a la administración subcutánea (49) . Incluso la proporción de pacientes que reportan problemas en el EQ-5D están dispuestos a aceptar mayores riesgos gastrointestinales o cardiovasculares a cambio de más energía, al pasar de una inyección subcutánea administrada en casa una vez cada 2 semanas a un comprimido oral administrado en casa tres veces por semana (48) .…”

Anaemia of Chronic Kidney Disease: Aligning Patient and Physician Awareness – Interviews with Three Key Opinion Leaders and Patient Advocates

“…1 Exacerbating the heavy burden of CKD, anaemia can negatively impact morbidity, mortality, and healthcare resources, as well as the daily functioning and emotional health of patients and their families. [2][3][4][5] However, differences between patients' and physicians' perceptions around anaemia and its treatment in CKD (aCKD) 6 could affect patient care. To provide insight on this topic, the views of a clinical expert in CKD, Christoph Wanner, and two patients/patient advocates with CKD, Daniel Gallego and Jemma Reast, were sought.…”

“…For example, in a European study of treatment preferences for anaemia of non-dialysis-dependent CKD, patients cited convenience of administration (mode/frequency), and an outcome of increased energy as important treatment attributes for which they would tolerate increased cardiovascular and gastrointestinal risk. 6 In contrast, physicians prioritised clinical efficacy, and while symptom improvement, in particular increased energy, was widely acknowledged as being meaningful for QoL, only a minority recognised mode of administration as being most important to patients. 6 These differences in viewpoint indicate that empowering patients to contribute to shared decision-making could be influential for the treatment of aCKD.…”

“…6 In contrast, physicians prioritised clinical efficacy, and while symptom improvement, in particular increased energy, was widely acknowledged as being meaningful for QoL, only a minority recognised mode of administration as being most important to patients. 6 These differences in viewpoint indicate that empowering patients to contribute to shared decision-making could be influential for the treatment of aCKD. Gallego considered the timescale of this approach: "To empower people you need education, not only information.…”

A retrospective view of the relationship of soluble Fas with anemia and outcomes in chronic kidney disease

“…Management of CKD-related anemia consists of erythropoiesis-stimulating agents (ESA) and iron replacement [10][11][12]. Even so, the blood transfusion required to treat anemia in patients with CKD continues to be widely used, especially in patients with inflammation status who progress to kidney failure with replacement therapy requirements [13,14].…”