title: Health related quality of life among patients with tuberculosis and HIV in Thailand.
abstract: BACKGROUND
  Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease.
  
  
  METHODS
  We collected health utility data from Thai patients who were on TB treatment or had been successfully treated for TB for the purpose of economic modeling. Structured questionnaire and EuroQol (EQ-5D) and EuroQol visual analog scale (EQ-VAS) instruments were used as data collection tools. We compared utility of patients with two co-morbidities calculated using multiplicative model (U(CAL)) with the direct measures and fitted Tobit regression models to examine factors predictive of health utility and to assess difference in health utilities of patients in various medical conditions.
  
  
  RESULTS
  Of 222 patients analyzed, 138 (62%) were male; median age at enrollment was 40 years (interquartile range [IQR], 35-47). Median monthly household income was 6,000 Baht (187 US$; IQR, 4,000-15,000 Baht [125-469 US$]). Concordance correlation coefficient between utilities measured using EQ-5D and EQ-VAS (U(EQ-5D) and U(VAS), respectively) was 0.6. U(CAL) for HIV-infected TB patients was statistically different from the measured U(EQ-5D) (p-value<0.01) and U(VAS) (p-value<0.01). In tobit regression analysis, factors independently predictive of U(EQ-5D) included age and monthly household income. Patients aged ≥40 years old rated U(EQ-5D) significantly lower than younger persons. Higher U(EQ-5D) was significantly associated with higher monthly household income in a dose response fashion. The median U(EQ-5D) was highest among patients who had been successfully treated for TB and lowest among multi-drug resistant TB (MDR-TB) patients who were on treatment.
  
  
  CONCLUSIONS
  U(CAL) of patients with two co-morbidities overestimated the measured utilities, warranting further research of how best to estimate utilities of patients with such conditions. TB and MDR-TB treatments impacted on patients' self perceived health status. This effect diminished after successful treatment.
authors.affiliation: Thailand Ministry of Public Health, U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand. wanitchayak@th.cdc.gov
authors.forename: Wanitchaya
authors.initials: W
authors.lastname: Kittikraisak
authors.forename: Pritaporn
authors.initials: P
authors.lastname: Kingkaew
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
authors.forename: Jomkwan
authors.initials: J
authors.lastname: Yothasamut
authors.forename: Supalert
authors.initials: S
authors.lastname: Natesuwan
authors.forename: Weerawat
authors.initials: W
authors.lastname: Manosuthi
authors.forename: Virasakdi
authors.initials: V
authors.lastname: Chongsuvivatwong
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Whitehead
mesh_terms: D000328:Adult; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006262:Health; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D010147:Pain Measurement; D011788:Quality of Life; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology