Does Cirrhosis Affect Quality of Life in HCV Patients?
Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with impairments in health-related quality of life.
Aims: To evaluate quality of life (QOL) in cirrhotic (compensated and decompensated) and non-cirrhotic patients with chronic HCV infection, using preference-based (utilities) and non-preference-based methods of evaluating QOL.
Methods: In a tertiary care setting, 271 patients completed a self-administered time trade-off utility instrument, the Health Utility Index Mark 2 and Mark 3, and the Hepatitis Quality of Life Questionnaire Version 2. Mean QOL scores were compared across HCV disease stages and sociodemographical categories. We examined the association between QOL and disease stage using linear regression adjusting for age, education, marital status, log income and Charlson comorbidity scores. Mean utility scores were compared across disease stages using a propensity score method.
Results: Mean utilities were lower than general population norms (0.81-0.92) and ranged from 0.62 to 0.82 in non-cirrhotic patients (n = 197), 0.56-0.84 in compensated cirrhotic patients (n = 17) and 0.55-0.76 for decompensated cirrhotic patients (n = 57). No significant association found was between disease stage and utility for current health status. Higher income, fewer comorbidities and living in a married or common-law relationship were significantly associated with higher utilities and better QOL. No significant difference in utilities was found between disease stages using propensity score matching.
Conclusions: Our study confirms that changes in HCV disease stage explain only small changes in QOL and suggests that factors such as underlying comorbidities, income and marital status have a greater effect on QOL than disease stage.
More than 170 million people worldwide are chronically infected with the hepatitis C virus (HCV). Chronic infection with HCV may have serious consequences; 15-20% of those with chronic infection will develop cirrhosis after 20 years and of these, 5-10% will develop hepatocellular carcinoma. HCV is now a major cause of chronic liver disease and is the leading indication for liver transplantation in developed countries. In addition to its effects on progression of liver disease, HCV infection may also be associated with impairments in health-related quality of life (QOL) including fatigue, muscle and joint pain, depression, and other psychological disorders, even in the early stages of disease. To date, the majority of studies examining the effects of HCV on QOL utilize non-preference-based measurements such as the Short-Form 36 (SF-36). Although these generic instruments are useful in describing health states and their effects on function and disability, they do not directly measure individual preferences for health outcomes.
Health utility is a preference-based measure of QOL that ascertains an individual's value or preference for a particular health state. Utilities are reported from a scale of 0 (dead) to 1 (full health) and can be obtained either (i) directly from individuals using time trade-off or standard gamble techniques or (ii) indirectly using questionnaires that incorporate weights representing the preferences of the community. Utilities are widely used in cost-effectiveness and decision analyses where costs and benefits associated with different treatments are compared. There is a need for patient-elicited utilities in the HCV literature because most of the cost-effectiveness studies rely on clinical opinion or expert panels to estimate utilities and these may differ substantially from patient-derived utilities. The purpose of this study was to compare QOL across stages of HCV disease; specifically, we sought to evaluate QOL in chronically infected non-cirrhotic patients and cirrhotic patients (both compensated and decompensated), using both preference-based (utilities) and non-preference based methods of evaluating health outcomes.
Abstract and Introduction
Abstract
Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and is associated with impairments in health-related quality of life.
Aims: To evaluate quality of life (QOL) in cirrhotic (compensated and decompensated) and non-cirrhotic patients with chronic HCV infection, using preference-based (utilities) and non-preference-based methods of evaluating QOL.
Methods: In a tertiary care setting, 271 patients completed a self-administered time trade-off utility instrument, the Health Utility Index Mark 2 and Mark 3, and the Hepatitis Quality of Life Questionnaire Version 2. Mean QOL scores were compared across HCV disease stages and sociodemographical categories. We examined the association between QOL and disease stage using linear regression adjusting for age, education, marital status, log income and Charlson comorbidity scores. Mean utility scores were compared across disease stages using a propensity score method.
Results: Mean utilities were lower than general population norms (0.81-0.92) and ranged from 0.62 to 0.82 in non-cirrhotic patients (n = 197), 0.56-0.84 in compensated cirrhotic patients (n = 17) and 0.55-0.76 for decompensated cirrhotic patients (n = 57). No significant association found was between disease stage and utility for current health status. Higher income, fewer comorbidities and living in a married or common-law relationship were significantly associated with higher utilities and better QOL. No significant difference in utilities was found between disease stages using propensity score matching.
Conclusions: Our study confirms that changes in HCV disease stage explain only small changes in QOL and suggests that factors such as underlying comorbidities, income and marital status have a greater effect on QOL than disease stage.
Introduction
More than 170 million people worldwide are chronically infected with the hepatitis C virus (HCV). Chronic infection with HCV may have serious consequences; 15-20% of those with chronic infection will develop cirrhosis after 20 years and of these, 5-10% will develop hepatocellular carcinoma. HCV is now a major cause of chronic liver disease and is the leading indication for liver transplantation in developed countries. In addition to its effects on progression of liver disease, HCV infection may also be associated with impairments in health-related quality of life (QOL) including fatigue, muscle and joint pain, depression, and other psychological disorders, even in the early stages of disease. To date, the majority of studies examining the effects of HCV on QOL utilize non-preference-based measurements such as the Short-Form 36 (SF-36). Although these generic instruments are useful in describing health states and their effects on function and disability, they do not directly measure individual preferences for health outcomes.
Health utility is a preference-based measure of QOL that ascertains an individual's value or preference for a particular health state. Utilities are reported from a scale of 0 (dead) to 1 (full health) and can be obtained either (i) directly from individuals using time trade-off or standard gamble techniques or (ii) indirectly using questionnaires that incorporate weights representing the preferences of the community. Utilities are widely used in cost-effectiveness and decision analyses where costs and benefits associated with different treatments are compared. There is a need for patient-elicited utilities in the HCV literature because most of the cost-effectiveness studies rely on clinical opinion or expert panels to estimate utilities and these may differ substantially from patient-derived utilities. The purpose of this study was to compare QOL across stages of HCV disease; specifically, we sought to evaluate QOL in chronically infected non-cirrhotic patients and cirrhotic patients (both compensated and decompensated), using both preference-based (utilities) and non-preference based methods of evaluating health outcomes.
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