Conjoint Analysis of Treatment Preferences for Nondisplaced Scaphoid Fractures

Abstract

Purpose: We used conjoint analysis to assess the relative importance of factors that influence a patient's decision between surgical or nonsurgical management of a nondisplaced scaphoid fracture. Our hypothesis was that out-of-pocket costs will have a greater influence on decision making than the time spent in a cast or brace, degree of soreness, or the risk of treatment failure.

Methods: Two-hundred and fifty participants were recruited using Amazon Mechanical Turk and asked to assume that they had experienced a nondisplaced scaphoid waist fracture. They then indicated their relative preferences among 13 pairs of alternatives with variations in the following attributes: time in a cast, time in a brace, duration of ongoing soreness, risk of treatment failure (by which we meant scaphoid nonunion), out-of-pocket costs based on estimates of direct costs ($500-2,500), and apprehension about surgery. A conjoint analysis was used to determine the relative importance of these factors when choosing between surgical or nonsurgical management.

Results: The factor with the greatest influence on treatment choice was the cost of the procedure. After assessing the respondent's apprehension to undergo surgery, a sensitivity analysis showed the proportion of respondents who would choose surgery given different outcomes. To make the predicted share of those who are "not worried" about surgery equal to those who are "somewhat worried" or "a little worried" would require that the cost of surgery increase by $2,700. In addition, 2 weeks in a cast, 3 weeks in a brace, 2 months of soreness, or a 2% increase in the risk of fracture nonunion generates the same surgical choice probability as a $2,000 increase in the out-of-pocket cost of surgery.

Conclusions: As conceptualized in this conjoint analysis, out-of-pocket costs and apprehension about surgery seem to have a greater impact on a decision for surgery than the time spent in a brace or cast and the risk of treatment failure.

Type of study/level of evidence: Economic and decision analysis III.

Keywords: Conjoint analysis; hand surgery; patient preferences; scaphoid fracture; shared decision making.