Yasmin A Saeed1, Arcturus Phoon2, Joanna M Bielecki2, Nicholas Mitsakakis3, Karen E Bremner2, Lusine Abrahamyan4, Petros Pechlivanoglou5, Jordan J Feld6, Murray Krahn7, William W L Wong8. 1. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. Electronic address: yasmin.saeed@mail.utoronto.ca. 2. Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Biostatistics Research Unit, University Health Network, Toronto, ON, Canada. 4. Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 5. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada. 6. Toronto Centre for Liver Disease, University Health Network, Toronto, ON, Canada. 7. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 8. School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.
Abstract
BACKGROUND: Chronic hepatitis C (CHC) is among the most burdensome infectious diseases in the world. Health utilities are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE: Our study summarizes the available data on utilities in CHC patients. This will facilitate analyses of CHC treatment and elimination strategies. METHODS: We searched MEDLINE, Embase, and the Cochrane Library for studies measuring utilities in CHC patients. Utilities were pooled by health state and utility instrument using meta-analysis. A further analysis used meta-regression to adjust for the effects of clinical status and methodological variation. RESULTS: Fifty-one clinical studies comprising 15 053 patients were included. Based on the meta-regression, patients' utilities were lower for more severe health states (predicted mean EuroQol-5D-3L utility for mild/moderate CHC: 0.751; compensated cirrhosis: 0.671; hepatocellular carcinoma: 0.662; decompensated cirrhosis: 0.602). Patients receiving interferon-based treatment had lower utilities than those on interferon-free treatment (0.647 vs 0.733). Patients who achieved sustained virologic response (0.786) had higher utilities than those with mild to moderate CHC. Utilities were substantially higher for patients in experimental studies compared to observational studies (coefficient: +0.074, P < .05). The time tradeoff instrument was associated with the highest utilities, and the Health Utilities Index 3 was associated with the lowest utilities. CONCLUSION: Chronic hepatitis C is associated with a significant impairment in global health status, as measured by health utility instruments. Impairment is greater in advanced disease. Experimental study designs yield higher utilities-an effect not previously documented. Curative therapy can alleviate the burden of CHC, although further research is needed in certain areas, such as the long-term impacts of treatment on utilities.
BACKGROUND:Chronic hepatitis C (CHC) is among the most burdensome infectious diseases in the world. Health utilities are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE: Our study summarizes the available data on utilities in CHCpatients. This will facilitate analyses of CHC treatment and elimination strategies. METHODS: We searched MEDLINE, Embase, and the Cochrane Library for studies measuring utilities in CHCpatients. Utilities were pooled by health state and utility instrument using meta-analysis. A further analysis used meta-regression to adjust for the effects of clinical status and methodological variation. RESULTS: Fifty-one clinical studies comprising 15 053 patients were included. Based on the meta-regression, patients' utilities were lower for more severe health states (predicted mean EuroQol-5D-3L utility for mild/moderate CHC: 0.751; compensated cirrhosis: 0.671; hepatocellular carcinoma: 0.662; decompensated cirrhosis: 0.602). Patients receiving interferon-based treatment had lower utilities than those on interferon-free treatment (0.647 vs 0.733). Patients who achieved sustained virologic response (0.786) had higher utilities than those with mild to moderate CHC. Utilities were substantially higher for patients in experimental studies compared to observational studies (coefficient: +0.074, P < .05). The time tradeoff instrument was associated with the highest utilities, and the Health Utilities Index 3 was associated with the lowest utilities. CONCLUSION:Chronic hepatitis C is associated with a significant impairment in global health status, as measured by health utility instruments. Impairment is greater in advanced disease. Experimental study designs yield higher utilities-an effect not previously documented. Curative therapy can alleviate the burden of CHC, although further research is needed in certain areas, such as the long-term impacts of treatment on utilities.
Authors: Dr Nick Scott; Ms Anna Palmer; Mr Tom Tidhar; Prof Mark Stoove; Dr Rachel S Sacks-Davis; A/Prof Joseph S Doyle; Dr Alisa J Pedrana; Prof Alexander Thompson; Prof David P Wilson; Prof Margaret Hellard Journal: Lancet Reg Health West Pac Date: 2021-11-23
Authors: Raed A Joundi; Joel Adekanye; Alexander A Leung; Paul Ronksley; Eric E Smith; Alexander D Rebchuk; Thalia S Field; Michael D Hill; Stephen B Wilton; Lauren C Bresee Journal: J Am Heart Assoc Date: 2022-06-22 Impact factor: 6.106