Table 5.
Summary of findings: nonutility results for different treatment alternatives
| Health state/outcome (categories of values and preferences) | Estimates | Certainty in evidence |
|---|---|---|
| No. of participants/studies | ||
| Prophylaxis | ||
| Treatment method preferences: injections vs oral (Haac et al,49 Popoola et al,55 Quante et al,56 Sousou and Khorana,60 Wilke et al,62 Wong et al64) | The majority of patients prefer oral pills to subcutaneous injection (range, 60%-86%); the stated reasons include: easier to take and to integrate into the daily routine, less painful, and cost. For patients preferring the injection route, the reasons included faster onset of action, pill burden, and ease of use. | ⊕⊕⊕○ Moderate certainty due to serious RoB* |
| 1645 participants 1 RCT 3 cross-sectional studies 2 mixed-methods surveys | ||
| Treatment method preferences: LMWH vs EPC (Maxwell et al53) | The majority of patients were satisfied with the prophylactic method that they received to the extent that they would prefer the treatment they had received; a similar proportion of participants chose to receive the options they had received again after surgery (78% of those receiving LMWH and 74% of those receiving EPC). | ⊕⊕⊕○ Moderate certainty due to RoB† |
| 211 participants 1 cross-sectional study | ||
| Treatment method preferences: SCDs vs foot pumps (Roberston et al57) | Of a subgroup of 35 patients who had used both devices, 24 preferred the foot pump (69%), 7 preferred SCDs (20%), and 4 had no preference (11%). | ⊕○○○ Very low certainty due to serious RoB‡ and very serious imprecision§ |
| Subgroup of 35 participants who used both interventions from 1 cross-sectional study | ||
| Treatment management preferences: self-administration vs professional vs family/friend administration (Baba et al,41 Spahn82) | Variability in results, 1 study reporting a majority preference for professional or family administration of injections, whereas the other reported a majority preferring self-management. | ⊕⊕○○ Low certainty due to serious RoB¶ and inconsistency|| |
| 425 participants from 2 cross-sectional studies | ||
| Treatment | ||
| Treatment method preferences: warfarin vs DOACs (Lutsey et al52) | The majority of patients strongly prefer anticoagulants that are reversible (53%), and many of them (30%) prefer anticoagulants for which blood drug levels can be monitored. | ⊕⊕⊕○ Moderate due to serious RoB# |
| 519 participants from 1 cross-sectional study | ||
| Treatment method preferences: GCS type preferences (Lattimer et al,50 Williams et al63) | The majority (52%) of participants wanted to change their first assigned compression stocking, changes (in length, class, or size) may be required in determining a suitable GCS. Important variability is seen across studies: in 1 study, an above-knee thigh-length stocking was preferred by many patients (38%), whereas in the other study, all women preferred to wear below-knee stockings. | ⊕○○○ Very low certainty due to serious RoB** and very serious imprecision†† |
| 81 participants; 1 cohort study and 1 cross-sectional study | ||
| Management-type preferences/doctor-patient relationship (Barcellona et al42) | The doctor-patient relationship was considered very important by almost all patients (96%). They (93%) considered it important to be assessed by the doctor at the anticoagulation clinic and believed that doctors should always present the results personally (83%). | ⊕⊕⊕○ Moderate certainty due to RoB‡‡ |
| 264 participants from 1 cross-sectional study | ||
| Treatment management preferences: home based vs hospital based (Rymes et al59) | The majority of respondents preferred treatment at home (79%), and some expressed no preference (9%). Of all of these respondents, patients who had suffered a previous DVT and were treated in hospital stated that they preferred home treatment. | ⊕⊕○○ Low certainty due to very serious RoBa |
| 344 participants from 1 cross-sectional study | ||
| Cancer | ||
| Treatment method preferences: injections vs oral (Noble et al,54 Sousou and Khorana60) | Preference for oral administration over injection had moderate importance, although more patients were willing to use daily oral anticoagulants (86%) than to administer daily injections of anticoagulants (46%). | ⊕⊕⊕○ Moderate certainty due to RoBb |
| 290 participants from 2 cross-sectional studies | ||
| Treatment method preferences: LMWH vs EPC (Maxwell et al53) | The majority of patients were satisfied with the prophylactic method that they received to the extent that they would prefer the treatment they had received; a similar proportion of participants chose to receive the options they had received again after surgery (78% of those receiving LMWH and 74% of those receiving EPC). | ⊕⊕⊕○ Moderate certainty due to RoB† |
| 211 participants from 1 cross-sectional study | ||
| Treatment management preferences: self-administration vs professional/family administration (Baba et al41) | The majority of patients prefer a nurse to give the injection (40%), followed by family/friend (33.6%), and self-injection (25.6%). | ⊕⊕○○ Low certainty due to serious RoBc and imprecisiond |
| 160 participants from 1 cross-sectional study |
Moderate certainty in evidence: We are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty in evidence: Our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty in evidence: We have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
DOAC, direct oral anticoagulant; EPC, external pneumatic compression; GCS, graduated compression stockings; RCT, randomized controlled trial; SCD, sequential compression devices.
Popoola et al,55 Quante et al,56 Sousou and Khorana,60 and Wong et al64 directly asked which administration route the participants would prefer, without describing the possible consequence of the treatment.
Maxwell et al53 used forced choice method to elicit values and preferences, and the response rate was not reported.
Study directly asked which intervention the participants would prefer; potential bias due to measurement instrument, with only a very small subset of participants who had used both interventions.
Imprecision due to small sample size.
Studies directly asking which administration type the participants would prefer, with high RoB for measurement instrument, unclear sampling or response rates, and data analysis.
Variability in estimates: in 1 study, 38% preferred self-management, whereas in the other study, 92% preferred self-management.
Lutsey et al49 directly asked which administration type the participants would prefer.
The studies directly asked which administration route the participants would prefer, and the measurement instruments used are not validated.
Imprecision due to very small sample size.
Barcellona et al42 directly asked which administration route the participants would prefer, without describing the possible consequence of the treatment. High risk in health state presentation and instrument measurement.
The study directly asked which management option the participants would prefer, without describing the possible consequence of the treatment. High risk in health state presentation and instrument measurement.
Sousou and Khorana60 with high RoB for health state presentation and measurement instrument; the sampling methods are unclear in 2 studies, and the response rate is unknown in both studies.
Baba et al41 directly asked which type of care the participants would prefer, with high RoB for measurement instrument and unclear sampling and response rates.
Imprecision due to small sample size.