The impact of chronic hepatitis B on quality of life: A multinational study of utilities from infected and uninfected persons
The impact of chronic hepatitis B on quality of life: A multinational study of utilities from infected and uninfected persons
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DOI：
10.1111/j.1524-4733.2007.00297.x
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发表时间：
2008-05-01
期刊：
影响因子：
4.5
通讯作者：
Briggs, Andrew H.
中科院分区：
文献类型：
--
作者：
Levy, Adrian R.;Kowdley, Kris V.;Briggs, Andrew H.
目的：慢性乙型肝炎(CHB)是一种由于进行性肝损害而在世界范围内导致相当大的发病率和死亡率的疾病。对新的治疗药物进行经济评估的研究人员需要估计与健康相关的生活质量(HRQOL)。最近，越来越多的证据表明，文化背景的差异对人们对健康的看法有可量化的影响。研究目的是从居住在乙肝低流行和高流行地区的感染和未感染乙肝病毒的受访者中得出6种健康状态下的效用。方法：在美国、加拿大、英国、西班牙、香港和大陆中国，采用访谈者管理的调查方法，从肝炎患者和未感染的受访者中得出标准赌博效用。采用广义线性模型分析当前健康状况、年龄、性别、辖区、疾病状况对效用的影响。结果：样本包括534名慢性乙肝感染者和600名非感染者。CHB和代偿性肝硬变对HRQOL的影响中等，效用在0.68-0.80之间。失代偿性肝硬变和肝细胞癌的影响更大，效用在0.35到0.41之间。不同国家之间存在显著差异，中国大陆中国和香港的这两类受访者都报告了系统性的低效用。结论：与慢性乙肝感染相关的健康状况显著降低了高生存质量，本研究报告的效用为比较新的治疗方案提供了有价值的信息。观察到的国家间差异表明，经济评估可能受益于具体国家的效用估计。国家间公用事业的系统性差异在多大程度上适用于其他传染病和慢性病，仍然是一个悬而未决的问题，并对经济评估的适当进行和解释有相当大的影响。
Objectives: Chronic hepatitis B (CHB) is a condition that results in substantial morbidity and mortality worldwide because of progressive liver damage. Investigators undertaking economic evaluations of new therapeutic agents require estimates of health-related quality of life (HRQOL). Recently, evidence has begun to accumulate that differences in cultural backgrounds have a quantifiable impact on perceptions of health. The objective was to elicit utilities for six health states that occur after infection with the hepatitis B virus from infected and uninfected respondents living in jurisdictions with low and with high CHB endemicity.Methods: Standard gamble utilities were elicited from hepatitis patients and uninfected respondents using an interviewer-administered survey in the United States, Canada, United Kingdom, Spain, Hong Kong, and mainland China. Generalized linear models were used to the effect on utilities of current health, age and sex, jurisdiction and, for infected respondents, current disease state.Results: The sample included 534 CHB-infected patients and 600 uninfected respondents. CHB and compensated cirrhosis had a moderate impact on HRQOL with utilities ranging from 0.68 to 0.80. Decompensated cirrhosis and hepatocellular carcinoma had a stronger impact with utilities ranging from 0.35 to 0.41. Significant variation was observed between countries, with both types of respondents in mainland China and Hong Kong reporting systematically lower utilities.Conclusions: Health states related to CHB infection have substantial reductions in HRQOL and the utilities reported in this study provide valuable information for comparing new treatment options. The observed intercountry differences suggest that economic evaluations may benefit from country-specific utility estimates. The extent that systematic intercountry differences in utilities hold true for other infectious and chronic diseases remains an open question and has considerable implications for the proper conduct and interpretation of economic evaluations.