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Patient preferences for venous thromboembolism prophylaxis after injury: a discrete choice experiment
  1. Bryce E Haac1,
  2. Nathan N O'Hara1,
  3. C Daniel Mullins2,
  4. Deborah M Stein1,
  5. Theodore T Manson1,
  6. Herman Johal3,
  7. Renan Castillo4,
  8. Robert V O'Toole1,
  9. Gerald P Slobogean1
  1. 1 School of Medicine, University of Maryland, Baltimore, Maryland, USA
  2. 2 School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
  3. 3 Department of Surgery, McMaster University, Hamilton, Ontario, Canada
  4. 4 Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr. Nathan N O'Hara; nohara{at}umoa.umm.edu

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.

  • thromboembolism
  • anticoagulation
  • trauma management
  • adult surgery

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors BH contributed to the literature search, study design, data collection, data interpretation, writing and critical revision. NNO contributed to the literature search, study design, data analysis, data interpretation, writing and critical revision. CDM contributed to the data interpretation and critical revision. DS, TTM, HJ, RVO and GPS contributed to the literature search, study design, data interpretation and critical revision. RC contributed to the study design, data analysis, data interpretation and critical revision. All authors have approved the final version of the article submitted and agree to be accountable for all aspects of the work.

  • Funding Research reported in this manuscript was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-1511-32745). The views in this publication are solely the responsibility of the authors and do not necessarily represent the views of the PCORI, its board of governors or methodology committee.

  • Competing interests CDM reports consulting with Bayer, Daiichi Sankyo, Janssen/J&J, Mundipharma, NovoNordisk and Pfizer and receiving grants from Bayer, Novartis, Merck and Pfizer. TTM receiving grants from the US Air Force and serves as an advisor for Decisio Health. TTM reports consulting with Stryker, Globus and Smith & Nephew, being paid for expert testimony from various law firms and payment for lectures by the Maine Review Course. RVOT reports consulting with Coorstek (Zimmer) and Smith & Nephew and receiving royalties from Coorstek. GPS reports payments for presenting by Zimmer Biomet. No other disclosures were reported.

  • Patient consent Obtained

  • Ethics approval University of Maryland Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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