Eckman Mark H, Adejare Adeboye A, Duncan Heather, Woodle E Steve, Thakar Charuhas V, Alloway Rita R, Sherman Kenneth E
Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, Ohio.
Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio.
MDM Policy Pract. 2021 Oct 29;6(2):23814683211056537. doi: 10.1177/23814683211056537. eCollection 2021 Jul-Dec.
While use of (hepatitis C virus) HCV-viremic kidneys may result in net benefit for the average end-stage kidney disease (ESKD) patient awaiting transplantation, patients may have different values for ESKD-related health states. Thus, the best decision for any individual may be different depending on the balance of these factors. Our objective was to explore the feasibility of sampling health utilities from hemodialysis patients in order to perform patient-specific decision analyses considering various transplantation strategies. We assessed utilities on a convenience sample of hemodialysis patients for health states including hemodialysis, and transplantation with either an HCV-uninfected kidney or an HCV-viremic kidney. We performed patient-specific decision analyses using each patient's age, race, gender, dialysis vintage, and utilities. We used a Markov state transition model considering strategies of continuing hemodialysis, transplantation with an HCV-unexposed kidney, and transplantation with an HCV-viremic kidney and HCV treatment. We interviewed 63 ESKD patients from four dialysis centers (Dialysis Clinic Inc., DCI) in the Cincinnati metropolitan area. Utilities for ESKD-related health states varied widely from patient to patient. Mean values were highest for -transplantation with an HCV-uninfected kidney (0.89, SD: 0.18), and were 0.825 (SD: 0.231) and 0.755 (SD: 0.282), respectively, for hemodialysis and transplantation with an HCV-viremic kidney. Patient-specific decision analyses indicated 37 (59%) of the 63 ESKD patients in the cohort would have a net gain in quality-adjusted life years from transplantation of an HCV-viremic kidney, while 26 would have a net loss. It is feasible to gather dialysis patients' health state utilities and perform personalized decision analyses. This approach could be used in the future to guide shared decision-making discussions about transplantation strategies for ESKD patients.
虽然使用丙型肝炎病毒（HCV）血症的肾脏可能会给等待移植的终末期肾病（ESKD）患者带来净收益，但患者对与ESKD相关的健康状态可能有不同的价值观。因此，对于任何个体而言，最佳决策可能因这些因素的平衡而有所不同。我们的目标是探讨从血液透析患者中获取健康效用值的可行性，以便针对各种移植策略进行患者特异性决策分析。我们对血液透析患者的便利样本进行了健康状态效用评估，这些健康状态包括血液透析、移植未感染HCV的肾脏或感染HCV的肾脏。我们使用每位患者的年龄、种族、性别、透析时间和效用值进行患者特异性决策分析。我们使用了一个马尔可夫状态转移模型，该模型考虑了继续血液透析、移植未接触HCV的肾脏、移植感染HCV的肾脏以及HCV治疗等策略。我们采访了辛辛那提都会区四个透析中心（透析诊所公司，DCI）的63名ESKD患者。与ESKD相关的健康状态的效用值在患者之间差异很大。未感染HCV的肾脏移植的平均效用值最高（0.89，标准差：0.18），血液透析和感染HCV的肾脏移植的平均效用值分别为0.825（标准差：0.231）和0.755（标准差：0.282）。患者特异性决策分析表明，该队列中的63名ESKD患者中有37名（59%）从移植感染HCV的肾脏中获得质量调整生命年的净收益，而26名患者会有净损失。收集透析患者的健康状态效用值并进行个性化决策分析是可行的。这种方法未来可用于指导关于ESKD患者移植策略的共同决策讨论。
