Assessment of health-related quality of life and health utilities in Australian patients with cirrhosis

Steven M McPhail; Samath Amarasena; Katherine A Stuart; Kelly Hayward; Rohit Gupta; David Brain; Gunter Hartel; Tony Rahman; Paul J Clark; Christina M Bernardes; Richard Skoien; Benjamin Mckillen; Andrew Lee; Leshni Pillay; Lei Lin; Myat Myat Khaing; Leigh Horsfall; Elizabeth E Powell; Patricia C Valery

doi:10.1002/jgh3.12462

Assessment of health-related quality of life and health utilities in Australian patients with cirrhosis

JGH Open. 2020 Dec 10;5(1):133-142. doi: 10.1002/jgh3.12462. eCollection 2021 Jan.

Authors

Steven M McPhail^{1

2}, Samath Amarasena³, Katherine A Stuart⁴, Kelly Hayward⁵, Rohit Gupta⁶, David Brain^{1

2}, Gunter Hartel⁷, Tony Rahman⁶, Paul J Clark⁸, Christina M Bernardes⁶, Richard Skoien³, Benjamin Mckillen³, Andrew Lee⁸, Leshni Pillay⁹, Lei Lin⁶, Myat Myat Khaing⁶, Leigh Horsfall^{4

5}, Elizabeth E Powell^{4

5}, Patricia C Valery⁷

Affiliations

¹ Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia.
² Clinical Informatics Directorate Metro South Health Brisbane Queensland Australia.
³ Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia.
⁴ Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.
⁵ Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia.
⁶ Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia.
⁷ QIMR Berghofer Medical Research Institute Brisbane Queensland Australia.
⁸ Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Queensland Australia.
⁹ Department of Gastroenterology and Hepatology Logan Hospital Brisbane Queensland Australia.

Abstract

Background and aim: Health-related quality-of-life measurements are important to understand lived experiences of patients who have cirrhosis. These measures also inform economic evaluations by modelling quality-adjusted life years (QALYs). We aimed to describe health-related quality of life, specifically multiattribute utility (scale anchors of death = 0.00 and full health = 1.00), across various stages and etiologies of cirrhosis.

Methods: Face-to-face interviews were used to collect Short Form 36 (SF-36) questionnaire responses from CirCare study participants with cirrhosis (June 2017 to December 2018). The severity of cirrhosis was assessed using the Child-Pugh score classified as class A (5-6 points), B (7-9), or C (10-15) and by the absence ("compensated") versus presence ("decompensated") of cirrhosis-related complications.

Results: Patients (n = 562, average 59.8 years [SD = 11.0], male 69.9%) had a range of primary etiologies (alcohol-related 35.2%, chronic hepatitis C 25.4%, non-alcoholic fatty liver disease (NAFLD) 25.1%, chronic hepatitis B 5.9%, "other" 8.4%). Significantly lower (all P < 0.001) mean multiattribute utility was observed in the health states of patients with decompensated (mean = 0.62, SD = 0.15) versus compensated cirrhosis (mean = 0.68, SD = 0.12), Child-Pugh class C (mean = 0.59, SD = 0.15) or B (mean = 0.63, SD = 0.15) versus A (mean = 0.68, SD = 0.16), and between those of working age (18-64 years; mean = 0.64, SD = 0.16) versus those aged 65+ years (mean = 0.70, SD = 0.16). The greatest decrements in health-related quality of life relative to Australian population norms were observed across physical SF-36 domains.

Conclusions: Persons with more advanced cirrhosis report greater life impacts. Estimates from this study are suitable for informing economic evaluations, particularly cost-utility modelling, which captures the benefits of effective prevention, surveillance, and treatments on both the quality and quantity of patients' lives.

Keywords: chronic liver disease; health utilities; quality of life; short form‐36.