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Health Values of Patients With Chronic Hepatitis C Infection
Kenneth E. Sherman, MD, PhD;
Susan N. Sherman, DPA;
Thomas Chenier, PhD;
Joel Tsevat, MD, MPH
Arch Intern Med. 2004;164:2377-2382.
Background Patients with hepatitis C virus (HCV) infection report a reduction in health status, but it is not known how they value their state of health. We assessed health utilities directly from patients with HCV infection.
Methods One hundred twenty-four patients with chronic HCV infection representing a cross section of disease severity were administered a disease-specific version of the Medical Outcomes Study 36-Item Short-Form Health Survey, the Beck Depression Inventory, and 3 direct health value measures, including the Rating Scale, Time Trade-off (TTO), and Standard Gamble (SG). Correlation among measures and factor analysis was performed.
Results The mean modified Medical Outcomes Study 36-Item Short-Form Health Survey scores were lower than normative population values, particularly on the Physical Component Summary scale. This scale was poorly correlated with the Rating Scale, TTO, and SG scores among HCV-infected subjects. The mean ± SE TTO score was 0.83 ± 0.02, and the mean ± SE SG score was 0.79 ± 0.02. The TTO and SG scores failed to show significant variability in relation to disease activity as determined by serum alanine aminotransferase level, histologic stage, and presence of decompensated liver disease. The Beck Depression Inventory was significantly inversely correlated with the TTO and SG.
Conclusions Although quality of life is compromised in patients with chronic HCV infection, patient-derived health utilities are not strongly associated with health status or clinical measures. Utility measures obtained from patients with HCV differ significantly from previous surrogate measures of health values. Such differences in utilities could affect decision analyses and cost-effectiveness analyses of treatment interventions for individuals with HCV infection.
Author Affiliations: Hepatology and Liver Transplant Medicine Section, Division of Digestive Diseases, Department of Medicine, and Institute for Health Policy and Health Services Research, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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