Patient preferences for venous thromboembolism prophylaxis after injury: a discrete choice experiment

Abstract

ObjectiveLimited 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).DesignDiscrete choice experiment (DCE).SettingLevel 1 trauma center in Baltimore, USA.Participants232 adult trauma patients (mean age 47.9 years) with pelvic or acetabular fractures or operative extremity fractures.Primary and secondary outcome measuresRelative 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.ResultsPatients 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).ConclusionsPatients 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.

Patient values and preferences regarding VTE disease: a systematic review to inform American Society of Hematology guidelines

“…27,28 Lloyd et al, 31 Locadia et al, 32 Marvig et al, 34 Utne et al 37 27,28 Lloyd et al, 31 Locadia et al, 32 Marvig et al, 34 Tavoly et al, 36 Utne et al 37 ) Range across studies: 0. Gastrointestinal tract bleeding event (Hogg et al, 27 Lloyd et al, 31 Studies assessing the RIOs that medical and surgical patients place on VTE prophylaxis benefits and adverse events showed that VTE risk reduction is a more important factor influencing their preferences than the potential harms of the treatment (510 participants from 3 studies; high certainty) 38,49,56 ( Table 3). The same was true for patients treated for VTE, who held greater concerns for recurrent VTE risk (519 participants from 1 study; moderate certainty).…”

“…†Imprecision due to small sample size. 49 Quante et al, 56 Westrich et al 38 ) Patients highly value the benefits of VTE risk reduction of VTE prophylaxis. Preferences changed in favor of subcutaneous injections with an absolute risk reduction of only 1.27% in VTE, also with the assumption of a generally better effectivity (47.4% of patients).…”

“…41,42,49,50,[52][53][54][55][56][57]59,60,[62][63][64]82 Six of those studies evaluated the preference for injections or oral administration routes in 1645 medical or surgical patients receiving prophylaxis. 49,55,56,60,62,64 There was a clear preference for oral medication (range, 60-86% of patients) over subcutaneous injection, because it is easier to take and to integrate into the daily routine, and it is also perceived as less painful and less expensive. For participants preferring the injection route, the stated reasons for the preferences included faster onset of action, avoidance of pill burden, and ease of use (1645 participants from 6 studies; moderate certainty).…”

“…a Cajfinger et al 46 directly asked which administration route the participants would prefer, without describing the possible consequence of the treatment; the response rate is unknown in both studies. 49 Popoola et al, 55 Quante et al, 56 Sousou and Khorana, 60 Wilke et al, 62 Wong et al 64 ) The majority of patients prefer oral pills to subcutaneous injection (range, 60%-86%); the stated reasons include: easier to take and to integrate into the daily routine, less painful, and cost. For patients preferring the injection route, the reasons included faster onset of action, pill burden, and ease of use.…”

Treatment preferences in people with haemophilia A or caregivers of people with haemophilia A: A discrete choice experiment

“…13 Other experiments in other therapeutic areas have reported a preference for SC injection rather than IV delivery: including in ulcerative colitis 29 and rheumatoid arthritis. 30 However, in these and other settings, sometimes patients have the option of oral formulations, which are preferred over SC administration, 29,31…”