Consumer Preferences for Total Ankle Arthroplasty Versus Ankle Arthrodesis: A Conjoint Analysis of 1,410 US Healthcare Consumers.

Abstract

Few studies have analyzed consumer preferences for total ankle arthroplasty (TAA) versus ankle arthrodesis (AA). The purpose of this study was to understand consumer preferences for TAA and AA based on cost, outcomes, and other treatment attributes. A conjoint analysis was developed and distributed using Amazon Mechanical Turk to US healthcare consumers. Respondents were educated on treatment options for end-stage ankle osteoarthritis and asked to indicate preference for TAA or AA based on attributes of each procedure. Attributes consisted of ankle range of motion, activity restriction, out-of-pocket cost, frequency of follow-up appointments, length of time non-weightbearing, and risk of additional surgery. Multivariate regression analysis was used to determine associations between healthcare consumer characteristics and treatment preferences. The study cohort (n = 1,410) was 50% male with a mean age of 34 (range 19 to 66) years. Respondents indicated that ankle range of motion was most important, with chance of additional surgery being least important. Most respondents preferred TAA over AA (72%). Multivariate regression analysis identified several healthcare consumer characteristics associated with TAA preference including male sex, higher level of education, current or previous position in health care, and history of lower extremity surgery. Conversely, increased household income and history of moderate exercise were associated with AA preference. No difference was noted in willingness to pay between TAA or AA at different price points. Several characteristics were associated with preference for TAA over AA and vice versa, which can be useful when counseling patients on treatment options for end-stage ankle osteoarthritis.