Health-state utilities and quality of life in hepatitis C patients
Health-state utilities and quality of life in hepatitis C patients
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DOI：
10.1016/s0002-9270(02)06054-9
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发表时间：
2003-03-01
影响因子：
9.8
通讯作者：
Krahn, M
中科院分区：
文献类型：
--
作者：
Chong, CAKY;Gulamhussein, A;Krahn, M
目的：健康状态效用是从0（死亡）到I（完全健康）的生活质量的全球测量。效用用于评估健康结果，是确定治疗成本效益的政策模型的首选结果衡量标准。目前，丙型肝炎病毒（HCV）感染患者的效用已经使用专家判断进行了估计。本研究的目的是直接从patients.METHODS引出HCV效用：我们评估了193例门诊患者在慢性HCV进展的各个阶段的效用，通过使用视觉模拟量表，标准赌博技术，健康效用指数马克3调查，和欧洲生活质量指数调查。我们还纳入了基于非效用的简表-36v2调查，它提供了一个详细的健康状况。结果：平均标准赌博效用为：0.78为患者没有最近的肝活检和没有迹象的肝硬化，0.79为轻度至中度慢性丙型肝炎病毒感染，0.80为代偿性肝硬化，0.60为失代偿性肝硬化，0.72为肝细胞癌，0.72为肝硬化。0.73用于移植; 0.86用于对干扰素+/-利巴韦林治疗的持续病毒学应答者。健康效用指数Mark 3调查和EuroQol指数调查效用低于加拿大人口标准（p < 0.001）。对于轻度/中度慢性感染和持续病毒学应答者，患者引发的效用低于先前的专家估计，但对于失代偿性肝硬化和肝细胞癌，患者引发的效用高于先前的专家估计。简表-36v2调查分数显示了几个显著的健康损害结论：这些发现1）表明HCV临床谱的生活质量（QOL）差异比以前认为的要小; 2）支持其他证据表明HCV患者的QOL显著降低;和3）提供直接来源于HCV患者的实用价值。
OBJECTIVE: Health-state utilities are global measurements of quality of life on a scale from 0 (death) to I (full health). Utilities are used to evaluate health outcomes and are the preferred outcome measure for policy models that determine the cost-effectiveness of treatments. Currently, utilities for hepatitis C virus (HCV)-infected patients have been estimated using expert judgments. The purpose of this study was to elicit HCV utilities directly from patients.METHODS: We assessed the utilities of 193 outpatients at various stages of chronic HCV progression by using a visual analog scale, the standard gamble technique, the Health Utilities Index Mark 3 survey, and the EuroQol Index survey. We also incorporated the nonutility-based Short Form-36v2 survey, which provides a detailed profile of health status.RESULTS: The mean standard gamble utilities were: 0.78 for patients without a recent liver biopsy and no signs of cirrhosis; 0.79 for mild to moderate chronic HCV infection; 0.80 for compensated cirrhosis; 0.60 for decompensated cirrhosis; 0.72 for hepatocellular carcinoma; 0.73 for transplant; and 0.86 for sustained virological responders to interferon +/- ribavirin treatment. The Health Utilities Index Mark 3 survey and the EuroQol Index survey utilities were lower than Canadian population norms (p < 0.001). Patient-elicited utilities were lower than previous expert estimates for mild/moderate chronic infection and sustained virological responders, but higher for decompensated cirrhosis and hepatocellular carcinoma. The Short Form-36v2 survey scores revealed several significant health impairments (p < 0.005) when compared with U.S. population norms.CONCLUSIONS: These findings 1) suggest that quality of life (QOL) differences across the HCV clinical spectrum are smaller than previously believed; 2) support other evidence suggesting that QOL is significantly diminished in HCV patients; and 3) provide utility values derived directly from HCV patients.