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Sustained Responders Have Better Quality of Life and Productivity Compared With Treatment Failures Long After Antiviral Therapy for Hepatitis C

John-Baptiste, Ava A., MHSc1,2,3; Tomlinson, George, PhD1,2,3,4; Hsu, Priscilla C., MHA5,6; Krajden, Mel, MD, FRCPC5,6; Heathcote, Jenny E., MD1,2; Laporte, Audrey, MA, PhD1; Yoshida, Eric M., MD, MHSc, FRCPC7; Anderson, Frank H., MD, FRCPC8; Krahn, Murray D., MD, MSc, FRCPC1,2,3,9

American Journal of Gastroenterology: October 2009 - Volume 104 - Issue 10 - p 2439–2448
ORIGINAL CONTRIBUTIONS
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OBJECTIVES: 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.

Am J Gastroenterol 2009; 104:2439-2448; doi:10.1038/ajg.2009.346; published online 30 June 2009

1Department of Health Policy, Management and Evaluation and Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 2University Health Network, Toronto, Ontario, Canada; 3Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; 5British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada; 6Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada; 7Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada; 8Liver and Intestinal Research Centre, Vancouver, British Columbia, Canada; 9Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. Correspondence: Ava A. John-Baptiste, MHSc, Department of Health Policy, Management and Evaluation and Faculty of Medicine, University of Toronto, Toronto General Hospital, EN13-239, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4. E-mail: a.john.baptiste@utoronto.caReceived 12 March 2009; accepted 14 May 2009

© The American College of Gastroenterology 2009. All Rights Reserved.
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