MO528: Identifying Drivers of Patients’ and Physicians’ Preferences for Treatments of Anemia of Chronic Kidney Disease: A Qualitative Study
Authors: Lu Ember , Okoro Tony , Heidenreich Sebastian , Mulnick Sarah , Seo Jaein , Dhillon Harjeet , Refoios Camejo Rodrigo 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Anemia is an important and common complication of chronic kidney disease (CKD). As the treatment landscape evolves, improving our limited understanding of patient and physician preferences for the management of anemia of CKD may help to better address patients’ treatment needs. Qualitative interviews were conducted to identify key treatment aspects that affect patients’ and physicians’ treatment preferences.

METHOD
A targeted literature informed the design and content of semi-structured qualitative interviews. All interviews were conducted (by telephone, in local language) with CKD patients (non-dialysis dependent and peritoneal dialysis dependent) and physicians from the USA, Germany and Japan. Interviews comprised of three parts. Part 1 discussed patients’ symptoms and quality of life, while physicians were asked about their clinical experience. Part 2 covered treatment experience and concerns, and included semi-structured discussions about benefits, adverse events and convenience. In part 3, patients and physicians were presented with a hypothetical treatment choice that required benefit–risk trade-offs. All data were analyzed using mixed deductive and inductive analysis, and results were visualized using a conceptual map. Subsequently, an attribute selection workshop was held with nephrologists from the USA and Germany, in which findings from the literature review and qualitative interviews were reviewed at length to identify drivers for patient and physician preferences for anemia treatments.

RESULTS
A total of 18 patients (n = 6 from each country) and 12 physicians (n = 4 from each country) participated in the qualitative interviews. Patients were at least in CKD stage 3 with 50% in stage 5. Most patients (72%) were receiving treatment with a recombinant human erythropoietin. Most frequently reported comorbidities were hypertension (78%), type 2 diabetes (46%) and hyperlipidemia (22%). All physicians had been in clinical practice for 40–50 years and 75% were in private practice. Figure 1 depicts the attribute conceptual map. Control of hemoglobin within target range was important to both patients and physicians. Physicians linked hemoglobin control to fewer symptoms and better quality of life. Nine out of 12 physicians (75%) spontaneously stated that they were concerned about the cardiovascular (CV) risk associated with use of erythropoiesis-stimulating agents. Patients reported experiencing several symptoms associated with anemia of CKD, with fatigue/tiredness (lack of energy) and dizziness being the most common. Physicians also highlighted these as important, and patients linked improvements in lack of energy to treatment success. Patients raised concerns about the convenience of intravenous (time commitment) and subcutaneous (storage requirements, self-injection) administration, but considered oral pills to be convenient and familiar. Once-daily administration of oral pills was considered easier to remember than thrice weekly.

CONCLUSION
This study demonstrated that patient and physician treatment preferences are multi-factorial, driven by clinically important attributes such as keeping within hemoglobin target ranges, reducing fatigue and weakness and the risk of CV side effects. Drug regimen attributes such as dosing frequency and dosing requirements affected perceived convenience. While all aspects contribute jointly to perceived value, they appear to have different relative importance. These findings are suitable for designing a subsequent preference elicitation survey that will aim to elicit trade-offs between the relevant treatment aspects and better understand patient and physician preferences.
Sponsorship: GlaxoSmithKline (Study number: 213 496).