Sustained responders have better quality of life and productivity compared with treatment failures long after antiviral therapy for hepatitis C.
OBJECTIVE
We sought to compare the health status of patients with a sustained response to antiviral therapy for hepatitis C virus (HCV) infection with that of treatment failures, using health-related quality of life and preference (utility) measures.


METHODS
Sustained responders had undetectable HCV viral levels 6 months after antiviral therapy. After antiviral therapy, participants completed, by mail or interview, the hepatitis-specific Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), the Health Utilities Index Mark 2/3 (HUI2/3), and time trade-off (TTO) for current health. The respondents provided information on demographics, history of substance abuse, comorbidities, and health history. Detailed clinical information was obtained by chart review. The respondents also indicated whether they missed work, volunteer opportunities, or household activities during the previous 3 months because of hepatitis C infection or its treatment.


RESULTS
A total of 235 patients (133 responders and 102 treatment failures) completed questionnaires at an average of 3.7 years after the end of treatment. Treatment failures had significantly lower scores on the eight SF-36 domains (P<0.01), lower scores on the hepatitis-specific domains (P<0.0001), and lower physical (42.5 vs. 49.2) and mental (40.5 vs. 46.1) component summary scores (P<0.01). HUI3 (0.57 vs. 0.70), HUI2 (0.74 vs. 0.80), SF-6D (0.65 vs. 0.71), and TTO (0.84 vs. 0.89) were lower for treatment failures (P<0.05). The regression-adjusted difference in HUI3, SF-6D, physical summary score, and mental summary score was 0.08 (P=0.04), 0.05 (P=0.004), 5.22 (P=0.001), and 5.73 (P<0.0001), respectively. Differences in the HUI2 and TTO scores were not significant after adjustment for demographic and clinical variables. Treatment failures were more likely to have missed work, volunteer opportunities, or household activities in the previous 3 months because of hepatitis C infection or its treatment (44 vs. 9%, P<0.001).


CONCLUSIONS
Patients with a sustained response to antiviral therapy for chronic HCV infection have better quality of life than treatment failures do. Our study validates the benefits associated with the sustained response to antiviral therapy in a real-world clinic population and shows that these benefits are maintained over the long term.
John-Baptiste
Ava A
AA
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto General Hospital, EN13-239, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada. a.john.baptiste@utoronto.ca
Tomlinson
George
G
Hsu
Priscilla C
PC
Krajden
Mel
M
Heathcote
E Jenny
EJ
Laporte
Audrey
A
Yoshida
Eric M
EM
Anderson
Frank H
FH
Krahn
Murray D
MD
D000203:Activities of Daily Living; D000998:Antiviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome
D000998:Antiviral Agents