Most Patients Prefer Medication to Surgery for SHPT
New survey shows that out-of-pocket costs are a major concern.
Hemodialysis (HD) patients not only comprehend the relative efficacies of secondary hyperparathyroidism (SHPT) treatments and tradeoffs, they demonstrate clear preferences.
In an online survey of 200 HD patients from the National Kidney Foundation's member database, Brett Hauber, PhD, of RTI Health Solutions in Park, North Carolina, and collaborators gauged preferences to 3 hypothetical SHPT therapies (2 medical and 1 surgical). For each option, information was provided on the treatment's effect on laboratory values and symptoms, safety, tolerability, mode of administration, and out-of-pocket cost. Medicine B, for example, showed 60% efficacy in keeping 3 lab values in range, a 5% chance of relieving symptoms, a 2% risk of hypocalcemia, moderate risk of nausea and vomiting, a weekly pill requirement, and $100 in monthly out-of-pocket costs.
Results published online in BMC Nephrology showed that the vast majority of respondents preferred medication to surgery. They voiced the most concern over a 1% risk of mortality with surgery compared with other potential complications, such as the possibilities of seizures or vocal cord damage.
Three-quarters of respondents preferred intravenous administration of medication via dialysis lines over pills for its convenience. They also considered the benefits of having a provider present. The mode of medication administration was relatively less important compared with other treatment aspects. Nausea and vomiting severity and hypocalcemia risk were also less concerning.
Out-of-pocket costs were a major concern. Household income was less than $30,000 a year for half of patients surveyed.
“Providers wishing to engage patients in shared decision making could use the attributes we identified as a reasonable starting point for discussions of which SHPT treatment may best meet a patient's needs and values,” Dr Hauber and colleagues stated. They noted that patient-education materials, teach-back techniques, and clinical practice guidelines are helpful in this pursuit.
The survey was developed using clinical literature, nephrologist input, patient-education resources, and a patient focus group. Respondents who opted to participate in the survey may not represent the entire HD population, and their results may not be generalizable. Only a quarter of respondents had SHPT; another 24% were unsure. Ten percent previously received a kidney transplant.
Hauber B, Caloyeras J, Posner J, Brommage D, Belozeroff V, and Cooper K. Hemodialysis patients' preferences for the management of secondary hyperparathyroidism. BMC Nephrol 2017:18;254. doi: 10.1186/s12882-017-0665-8