BACKGROUND
Background: Patients with End-Stage Kidney Disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is through the use of Hepatitis-C Viremic (HCV) kidneys.
OBJECTIVE
Objective: As preparation for developing a shared decision-making tool to assist ESKD patients with the decision whether to accept an HCV-viremic kidney transplant, we first wanted to assess the feasibility of using the Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Secondary goals were to collect ESKD patients’ utilities and to explore whether use of race-matched vs race-mismatched exemplars impacted knowledge gained during the assessment process.
METHODS
Methods: We used the Gambler II to elicit utilities for ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and post-intervention knowledge assessments.
RESULTS
Results: 63 hemodialysis patients from 4 outpatient Dialysis Center Inc. sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5 respectively. General group knowledge assessment scores improved by 10 points (p < 0.05) following utility assessment process.
CONCLUSIONS
Conclusion: Using The Gambler II to collect ESKD patients’ utilities in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients’ knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. Wide variation in patient health state utilities reinforces the importance of incorporating patients’ preferences into decisions regarding use of HCV-viremic kidneys for transplantation
Does the method for Military Utility Assessment of Future Technologies provide utility?
