A Systematic Review and Meta-Analysis of Health Utilities in Patients With Chronic Hepatitis C

Yasmin A Saeed; Arcturus Phoon; Joanna M Bielecki; Nicholas Mitsakakis; Karen E Bremner; Lusine Abrahamyan; Petros Pechlivanoglou; Jordan J Feld; Murray Krahn; William W L Wong

doi:10.1016/j.jval.2019.07.005

A Systematic Review and Meta-Analysis of Health Utilities in Patients With Chronic Hepatitis C

Value Health. 2020 Jan;23(1):127-137. doi: 10.1016/j.jval.2019.07.005. Epub 2019 Nov 28.

Authors

Affiliations

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.

PMID: 31952667
DOI: 10.1016/j.jval.2019.07.005

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.

Keywords: hepatitis C; patient preferences; patient-reported outcomes; quality of life; viral hepatitis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adult
Antiviral Agents / adverse effects
Antiviral Agents / economics*
Antiviral Agents / therapeutic use*
Cost of Illness
Cost-Benefit Analysis
Disease Progression
Drug Costs*
Female
Health Status
Hepatitis C, Chronic / diagnosis
Hepatitis C, Chronic / drug therapy*
Hepatitis C, Chronic / economics*
Humans
Male
Middle Aged
Patient Preference
Patient Reported Outcome Measures*
Quality of Life
Severity of Illness Index
Time Factors
Treatment Outcome

Substances

Antiviral Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding