BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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下肢截肢后患者对骨锚固修复体的偏好：荷兰的 2 中心离散选择实验 （PREFER-BAP-1）。


背景 涉及骨整合植入物的骨锚定修复体 （BAP） 在遇到窝相关问题的下肢截肢患者中的日益普及和使用导致人们对临床和功能结果测量的兴趣增加。然而，从患者的角度来看，BAP 治疗特征的价值尚未得到调查。本研究旨在使用在荷兰进行的 2 中心离散选择实验 （DCE） 确定特定 BAP 特征的相对重要性，以及并发症对生活质量 （QoL） 点和货币效用递减 （损失 [€]） 的影响。方法 根据文献回顾以及定性和定量方法，开发了 DCE，其中包括 BAP 治疗的最显着特征。选择以下特征：QoL 变化、短期和长期并发症、骨整合种植体存活率和自付费用 （成本）。在知情同意后，年龄在 18 至 99 岁之间且符合或已经接受骨整合植入物的患者被邀请参加，以引起 BAP 治疗偏好。使用了贝叶斯混合 logit 模型。结果 收集了 247 份已完成的调查;64% 的患者为男性，73% 接受过经股截肢术，33% 的患者有 >36 个月的 BAP 经验。患者认为长期并发症和 QoL 是最重要的特征。长期并发症的重要性是短期并发症的 3.4 倍。选择退出是不可取的，患者积极评价 BAP 特征的更好和有益水平 （与更好的结果相关）。 植入物移除是所有并发症中损失最大的水平，为 1.15 （95% 可信区间 [CI]，0.96 至 1.38）QoL 分和 16,940 欧元（95% CI，14,780 至 19,040 欧元）损失。结论 据我们所知，这是第一项使用 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，骨整合种植体团队和政策制定者在提出治疗方案时应考虑这些领域。此外，我们在患者观点、患者期望管理以及相关的 QoL 点损失和并发症继发的金钱损失方面的结果可以加强 BAP 治疗的政策和临床指南。证据级别 治疗级别 II .有关证据级别的完整描述，请参阅作者说明。