Estimating the impact of pill burden on health utilities in hemodialysis therapy

Patients undergoing hemodialysis often require numerous medications because of comorbidities including hyperphosphatemia, diabetes, and anemia, coupled with water restrictions. Reducing pill burden may alleviate psychological stress and improve quality of life (QOL). However, standardized instruments such as the EuroQOL 5 Dimensions inadequately measure these effects. We investigated the impact of pill burden on utility scores using a vignette-based time trade-off (TTO) method. Members of the general population were interviewed in person using vignettes representing seven health states with varying daily pill burdens (2, 3, 6, 9, 12, 24, and 36 tablets) in the context of hemodialysis patients, including disease characteristics, symptoms, and daily life restriction. Utility scores were evaluated using the TTO method and the impact of pill burden on QOL was estimated. The mean age (44.5 years) and sex distribution (50.5% male) of the 107 participants closely matched the general population of Japan. Utility scores decreased with higher pill burdens, ranging from 0.373 (0.579) [mean (standard deviation)] for 2 tablets/day to 0.239 (0.568) for 36 tablets/day. Compared with 2 tablets/day, the utility score for 6 tablets/day was significantly lower [mean (standard deviation) difference: 0.046 (0.223), P = 0.034, paired t-test)], with the difference showing a more significant as the number of tablets increased. Subgroup analyses by sex and age showed consistent trends with no significant differences between groups. A higher pill burden was associated with lower utility scores, highlighting its negative impact on QOL in patients undergoing hemodialysis. Reducing pill burden may improve QOL and address challenges related to water restrictions.