Quantifying the decrement in utility from perceived side effects of combination antiretroviral therapies in patients with HIV
Quantifying the decrement in utility from perceived side effects of combination antiretroviral therapies in patients with HIV
复制标题
DOI：
10.1111/j.1524-4733.2007.00315.x
复制
发表时间：
2008-09-01
期刊：
影响因子：
4.5
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
--
作者：
Braithwaite, R. Scott;Goulet, Joseph;Justice, Amy C.
背景：联合抗逆转录病毒疗法 (CART) 副作用导致的效用下降尚不清楚，可能会影响有关 CART 启动和成本效益的临床决策。目的：量化 CART 副作用导致的效用下降。方法：我们估计了 SF-6D 效用（生活质量权重，范围从 0.29 [最差的健康状况] 到 1.00 [完美的健康状况]）使用已发布且经过验证的转换算法，在退伍军人老龄化队列研究中对 HIV 患者进行 SF-12 评分。然后，我们比较了以下患者的效用：1）在服用 CART 时没有出现令人烦恼的症状； 2) 出现他们认为可能由 CART 引起的令人烦恼的症状； 3) 有令人烦恼的症状，他们确信是 CART 造成的；我们控制了已知影响生活质量的其他特征，并通过 CD4 计数进行分层分析。结果：在 1864 名拥有可用数据的患者中，被认为可归因于 CART 的症状与单变量分析中 0.06（0.05，0.08）点和多变量分析中 0.08（0.06，0.10）点的效用平均（95％置信区间）下降相关，临床上显着差异与报告的部分阳痿或轻度心绞痛的效用减少相当。 SF-6D 效用变化的其他重要预测因素包括危险饮酒、近期吸毒、吸烟、无家可归和非裔美国人种族 (R-2 = 0.12)。按 CD4 计数分层，CART 副作用引起的症状使效用降低 0.03 至 0.08 分。结论：被认为与 CART 相关的症状与效用大幅下降相关。
Background: The decrement in utility attributable to side effects from combination antiretroviral therapy (CART) is unknown and likely to influence clinical decisions regarding CART initiation and cost-effectiveness.Objective: To quantify the decrement in utility attributable to side effects from CART.Methods: We estimated SF-6D utilities (quality-of-life weights on a scale from 0.29 [worst possible health] to 1.00 [perfect health]) from SF-12 scores among patients with HIV in the Veterans Aging Cohort Study by using a published and validated conversion algorithm. We then compared utilities among patients who: 1) did not have bothersome symptoms while taking CART; 2) had bothersome symptoms that they thought might be due to CART; and 3) had bothersome symptoms that they were confident were due to CART; we controlled for other characteristics known to influence quality of life and stratified analyses by CD4 count.Results: Among 1864 patients with available data, symptoms perceived to be attributable to CART were associated with a mean (95% confidence interval) decrement in utility of 0.06 (0.05, 0.08) points in univariate analyses and 0.08 (0.06, 0.10) in multivariable analyses, clinically significant differences that are comparable to utility decrements reported for partial impotence or mild angina. Other significant predictors of changes in SF-6D utilities were hazardous alcohol consumption, recent drug use, cigarette smoking, homelessness, and African American race (R-2 = 0.12). Stratifying by CD4 count, symptoms attributable to CART side effects decreased utility by 0.03 to 0.08 points.Conclusions: Symptoms perceived to be related to CART are associated with a substantial decrement in utility.