Patient preferences for nutritional supplementation to improve fracture healing: A discrete choice experiment
PublisherBMJ Publishing Group
MetadataShow full item record
AbstractObjective: 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).
Identifier to cite or link to this itemhttps://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
- Patient preferences for venous thromboembolism prophylaxis after injury: a discrete choice experiment.
- Authors: Haac BE, O'Hara NN, Mullins CD, Stein DM, Manson TT, Johal H, Castillo R, O'Toole RV, Slobogean GP
- Issue date: 2017 Aug 11
- Post-fracture prescribed calcium and vitamin D supplements alone or, in females, with concomitant anti-osteoporotic drugs is associated with lower mortality in elderly hip fracture patients: a prospective analysis.
- Authors: Nurmi-Lüthje I, Lüthje P, Kaukonen JP, Kataja M, Kuurne S, Naboulsi H, Karjalainen K
- Issue date: 2009
- Effectiveness and safety of vitamin D in relation to bone health.
- Authors: Cranney A, Horsley T, O'Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V
- Issue date: 2007 Aug
- Do 25-Hydroxyvitamin D Levels Correlate With Fracture Complications?
- Authors: Bodendorfer BM, Cook JL, Robertson DS, Della Rocca GJ, Volgas DA, Stannard JP, Crist BD
- Issue date: 2016 Sep
- Economic Benefit of Calcium and Vitamin D Supplementation: Does It Outweigh the Cost of Nonunions?
- Authors: Childs BR, Andres BA, Vallier HA
- Issue date: 2016 Aug