Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
J Bone Joint Surg Am. 2024 Nov 6;106(21):2017-2027. doi: 10.2106/JBJS.24.00204. Epub 2024 Sep 6.
The rising popularity and use of a bone-anchored prosthesis (BAP) involving an osseointegrated implant for patients with lower-limb amputations experiencing socket-related issues have led to increased interest in the measurement of clinical and functional outcomes. However, the value of BAP treatment characteristics from the patient perspective has not yet been investigated. This study aimed to determine the relative importance of specific BAP characteristics, and the effect of complications in quality-of-life (QoL) points and monetary utility decrement (loss [€]), using a 2-center discrete choice experiment (DCE) conducted in The Netherlands.
A DCE was developed that included the most salient characteristics of BAP treatment based on a review of the literature and qualitative and quantitative methods. The following characteristics were selected: QoL change, short- and long-term complications, osseointegrated implant survival, and out-of-pocket contributions (costs). Patients aged 18 to 99 years who were eligible for, or had already received, an osseointegrated implant were invited to participate, after informed consent, to elicit BAP treatment preferences. A Bayesian mixed logit model was used.
Two hundred and forty-seven completed surveys were collected; 64% of the patients were male, 73% had undergone a transfemoral amputation, and 33% had >36 months of experience with a BAP. Patients considered long-term complications and QoL the most important characteristics. Long-term complications were 3.4 times more important than short-term complications. Opting out was undesirable, and patients valued better and beneficial levels (associated with better outcomes) of BAP characteristics positively. Implant removal was the level with the greatest loss among all complications, at 1.15 (95% credible interval [CI], 0.96 to 1.38) QoL points and €16,940 (95% CI, €14,780 to €19,040) loss.
To our knowledge, this is the first study to use a DCE to elicit patients' preferences regarding BAP treatment, outcomes, and related complications; we found that patients strongly care about long-term complications. The results suggest that osseointegrated implant teams and policy-makers should consider these areas when proposing treatment protocols. Furthermore, policy and clinical guidelines for BAP treatment could be enhanced by our results with respect to patients' perspectives, management of patients' expectations, and associated losses in QoL points and monetary loss secondary to complications.
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
随着骨整合植入物（BAP）的日益普及和使用，为下肢截肢患者提供了一种涉及骨整合的假体，以解决接受腔相关问题，这导致人们对临床和功能结果的测量越来越感兴趣。然而，从患者角度来看，BAP 治疗的特点的价值尚未得到研究。本研究旨在使用在荷兰进行的 2 中心离散选择实验（DCE）来确定特定 BAP 特征的相对重要性，以及并发症对生活质量（QoL）评分和货币效用损失（损失[€]）的影响。
根据文献综述和定性与定量方法，开发了 DCE，其中包括 BAP 治疗的最显著特征。选择了以下特征：QoL 变化、短期和长期并发症、骨整合植入物存活率和自付费用（成本）。在知情同意后，邀请年龄在 18 至 99 岁之间符合条件或已经接受过骨整合植入物的患者参与，以引出他们对 BAP 治疗的偏好。使用贝叶斯混合 logit 模型。
共收集了 247 份完成的调查问卷；64%的患者为男性，73%接受过股骨截肢，33%有 BAP 治疗经验超过 36 个月。患者认为长期并发症和 QoL 是最重要的特征。长期并发症比短期并发症重要 3.4 倍。选择退出是不可取的，患者对 BAP 特征的更好和有益水平（与更好的结果相关）给予积极评价。植入物去除是所有并发症中损失最大的一级，损失 1.15（95%可信区间[CI]，0.96 至 1.38）QoL 分和 16940 欧元（95%CI，14780 欧元至 19040 欧元）。
据我们所知，这是首次使用 DCE 来引出患者对 BAP 治疗、结果和相关并发症的偏好的研究；我们发现，患者非常关心长期并发症。结果表明，骨整合植入物团队和政策制定者在提出治疗方案时应考虑这些方面。此外，我们的研究结果可以增强 BAP 治疗的政策和临床指南，从患者的角度考虑，管理患者的期望，以及并发症导致的生活质量评分和货币损失的损失。
治疗水平 II。有关证据水平的完整描述，请参见作者说明。
