Ontology highlight
ABSTRACT: Objective
Limited evidence for the optimal venous thromboembolism (VTE) prophylaxis regimen in orthopaedic trauma leads to variability in regimens. We sought to delineate patient preferences towards cost, complication profile, and administration route (oral tablet vs. subcutaneous injection).Design
Discrete choice experiment (DCE).Setting
Level 1 trauma center in Baltimore, USA.Participants
232 adult trauma patients (mean age 47.9 years) with pelvic or acetabular fractures or operative extremity fractures.Primary and secondary outcome measures
Relative preferences and trade-off estimates for a 1% reduction in complications were estimated using multinomial logit modelling. Interaction terms were added to the model to assess heterogeneity in preferences.Results
Patients preferred oral tablets over subcutaneous injections (marginal utility, 0.16; 95% CI: 0.11 - 0.21, P<0.0001). Preferences changed in favor of subcutaneous injections with an absolute risk reduction of 6.98% in bleeding, 4.53% in wound complications requiring reoperation, 1.27% in VTE, and 0.07% in death from pulmonary embolism (PE). Patient characteristics (sex, race, type of injury, time since injury) affected patient preferences (P<0.01).Conclusions
Patients preferred oral prophylaxis and were most concerned about risk of death from PE. Furthermore, the findings estimated the trade-offs acceptable to patients and heterogeneity in preferences for VTE prophylaxis.
SUBMITTER: Haac BE
PROVIDER: S-EPMC5629686 | biostudies-literature | 2017 Aug
REPOSITORIES: biostudies-literature
Haac Bryce E BE O'Hara Nathan N NN Mullins C Daniel CD Stein Deborah M DM Manson Theodore T TT Johal Herman H Castillo Renan R O'Toole Robert V RV Slobogean Gerard P GP
BMJ open 20170811 8
<h4>Objective</h4>Limited evidence for the optimal venous thromboembolism (VTE) prophylaxis regimen in orthopaedic trauma leads to variability in regimens. We sought to delineate patient preferences towards cost, complication profile, and administration route (oral tablet vs. subcutaneous injection).<h4>Design</h4>Discrete choice experiment (DCE).<h4>Setting</h4>Level 1 trauma center in Baltimore, USA.<h4>Participants</h4>232 adult trauma patients (mean age 47.9 years) with pelvic or acetabular ...[more]