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Abstract Details
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.
Steven M McPhail12, Samath Amarasena3, Katherine A Stuart4, Kelly Hayward5, Rohit Gupta6, David Brain12, Gunter Hartel7, Tony Rahman6, Paul J Clark8, Christina M Bernardes6, Richard Skoien3, Benjamin Mckillen3, Andrew Lee8, Leshni Pillay9, Lei Lin6, Myat Myat Khaing6, Leigh Horsfall45, Elizabeth E Powell45, Patricia C Valery7
Author information
1Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia.
2Clinical Informatics Directorate Metro South Health Brisbane Queensland Australia.
3Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia.
4Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.
5Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia.
6Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia.
7QIMR Berghofer Medical Research Institute Brisbane Queensland Australia.
8Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Queensland Australia.
9Department 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.