Physicians' preference values for hepatitis C health states and antiviral therapy: a survey.
BACKGROUND
Physicians' perspectives regarding hepatitis C shape their approach to patient management. We used utility analysis to evaluate physicians' perceptions of hepatitis C-related health states (HS) and their threshold to recommend treatment.


METHODS
A written questionnaire was administered to practicing physicians. They were asked to rate hepatitis C health states on a visual analog scale ranging from 0% (death) to 100% (health without hepatitis C). Physicians then judged quality of life associated with the side effects of antiviral therapy for hepatitis C and indicated the sustained virological response rate that they would require to recommend treatment.


RESULTS
One hundred and thirteen physicians from five states were included. Median utility ratings for hepatitis C health states declined significantly with increasing severity of symptoms: HS1-No Symptoms, No Cirrhosis (88%; 12% reduction from good health), HS2-Mild Symptoms, No Cirrhosis (66%), HS3-Moderate Symptoms, No Cirrhosis (49%), HS4-Mild Symptoms, Cirrhosis (40%), HS5-Severe Symptoms, Cirrhosis (18%) [p < 0.001]. The median rating for life with side effects of antiviral therapy was 47%, suggesting a 53% reduction from good health. That was similar to the utility value for HS3-Moderate Symptoms, No Cirrhosis. The median threshold value for recommending treatment was a sustained response rate of 60%.


CONCLUSIONS
1) Physicians' utility ratings for hepatitis C health states were inversely related to the severity of disease manifestations described. 2) Physicians viewed side effects of therapy unfavorably and indicated that on average, they would require a 60% sustained response rate before recommending treatment, which far exceeds the efficacy of current antiviral therapy for hepatitis C in the majority of patients.
Patil
R
R
Section of Hepatology, RUSH-Presbyterian-St Luke's Medical Center, 1725 W Harrison St, Suite 306, Chicago, IL 60612, USA. rpatil@ameritech.net
Cotler
S J
SJ
Banaad-Omiotek
G
G
McNutt
R A
RA
Brown
M D
MD
Cotler
S
S
Jensen
D M
DM
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003625:Data Collection; D007722:Health Knowledge, Attitudes, Practice; D019698:Hepatitis C, Chronic / Q000145:classification* / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology; D010820:Physicians; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States
D000998:Antiviral Agents