Overview

Background Compared to in-center dialysis, home dialysis is associated with better quality of life and lower healthcare system costs. However, barriers remain to its wider adoption. Chronic disease, particularly at an advanced stage, is a major driver of socioeconomic vulnerability. Among dialysis patients, the proportion of individuals covered by France's Universal Health Protection scheme (PUMA) is higher than in the general population. Similarly, those from the most disadvantaged social classes are overrepresented among dialysis patients compared to the overall French population. Dialysis can also lead to job loss. Financial compensation schemes may influence the choice of home dialysis. In France, patients who perform dialysis at home-either independently or with help from a trained family caregiver-are eligible for a "third-person compensatory allowance" (DTP). For some socioeconomically vulnerable patients, eligibility for DTP may influence their decision to opt for home treatment. The DTP is specific to the French healthcare system but could be considered in other countries, particularly within the European Union. Indeed, in most countries with income levels comparable to France, the additional cost of home dialysis is borne by the patient. This study aims to determine whether receiving financial compensation plays a role in choosing a dialysis modality (home-based versus in-center or assisted home dialysis).

Objectives To investigate factors associated with patient preferences regarding renal replacement therapy.

Methods A discrete choice experiment (DCE) was conducted comparing two options: home dialysis (PD and HHD, with DTP) versus in-center hemodialysis (no DTP).

Perspectives If financial compensation influences patients' choices toward home dialysis, the DTP model could be used to address barriers to home-based treatment.

Eligibility

Inclusion Criteria:

• Adult patient
• Patient with advanced chronic kidney disease receiving pre-surgery information (presentation of methods)
• Patient enrolled in a social security program
• Patient able to read and understand French
• Patient able to complete the questionnaire (cognitive and sensory)

Exclusion Criteria:

• Minor patients
• Patients transitioning from one method of extrarenal purification to another
• Patients requiring urgent dialysis
• Patients who cannot read or understand French
• Patients under legal protection (guardianship, curatorship, judicial protection)