title: Health-state utilities and quality of life in hepatitis C patients.
abstract: OBJECTIVE
  Health-state utilities are global measurements of quality of life on a scale from 0 (death) to 1 (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.
authors.affiliation: Faculty of Medicine, University of Toronto, Ontario, Canada.
authors.forename: Christopher A K Y
authors.initials: CA
authors.lastname: Chong
authors.forename: Anar
authors.initials: A
authors.lastname: Gulamhussein
authors.forename: E Jenny
authors.initials: EJ
authors.lastname: Heathcote
authors.forename: Les
authors.initials: L
authors.lastname: Lilly
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006305:Health Status Indicators; D006526:Hepatitis C / Q000191:economics / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome