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    Patient preferences for nutritional supplementation to improve fracture healing: A discrete choice experiment

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    Author
    Nichols, E.
    O'Hara, N.N.
    Degani, Y.
    Date
    2018
    Journal
    BMJ Open
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.1136/bmjopen-2017-019685
    Abstract
    Objective: Vitamin D is often prescribed as an adjuvant therapy to aid fracture healing due to its biological role in bone health. However, the optimal frequency, dosage and duration of vitamin D supplementation for non-osteoporotic fracture healing has not been established. The objective of this study was to determine patient preferences for fracture healing relative to hypothetical vitamin D supplementation dosing options. Design: Discrete choice experiment. Setting: Level 1 trauma centre in Baltimore, Maryland, USA. Participants: 199 adult (18–60 years) patients with a fracture. Primary outcome measures: Parameter estimates of utility for fracture healing relative to dosing regimens were analysed using hierarchical Bayesian modelling. Results: A reduced risk of reoperation (34.3%) and reduced healing time (24.4%) were the attributes of greatest relative importance. The highest mean utility estimates were for a one-time supplementation dose (ß=0.71, 95% CI 0.41 to 1.00) followed by a reduced risk of reoperation (ß=0.41 per absolute % reduction, 95% CI 0.0.36 to 0.46). Supplementation for 24 weeks in duration (ß=−0.83, 95% CI −1.00 to −0.67) and a daily supplement (ß=−0.29, 95% CI −0.47 to −0.11) had the lowest mean utilities. The ‘no supplement’ option had a large negative value suggesting supplementation was generally desirable in this sample population. Among other possible clinical scenarios, patients expected a 2% reduction in the absolute risk of reoperation or a 3.1-week reduction in healing time from the baseline to accept a treatment regimen requiring two separate doses of supplementation, two blood tests and a cost of $20 within 3 months of injury. Conclusions: Patients with orthopaedic trauma demonstrated strong willingness to take a vitamin D supplement that would decrease risk of reoperation and reduce healing time. Furthermore, these findings specify the required decrease in reoperation risk and reduction in healing time patients would expect to adhere to possible vitamin D dosing regimens. Copyright 2018 Article author(s).
    Keyword
    discrete choice experiment
    fracture
    preferences
    Vitamin D
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85057140310&doi=10.1136%2fbmjopen-2017-019685&partnerID=40&md5=c1a49a3a79035041d4f9550abbd570e4; http://hdl.handle.net/10713/9426
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjopen-2017-019685
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