Can urban methadone patients complete health utility assessments?

Abstract

Objective-To assess the ability of methadone maintenance treatment (MMT) patients to use two standardized health assessment tools to value health states related to chronic hepatitis C virus (HCV) infection and HCV treatment-associated side effects. An estimated 65-90% of MMT patients are chronically infected with HCV.Methods-We employed qualitative methods to explore how patients completed computerized rating scale assessments and standard gamble utility assessments by 1) having them discuss their responses in a think-aloud interview immediately after each health state assessment, and 2) allowing them the opportunity to recalibrate prior responses after considering subsequent health states.Results-MMT patients used the rating scale boundaries appropriately and used the standard gamble to rank the health states in an a priori logical order. A guided assessment approach that allowed recalibration provided additional insight into values assigned to the health states presented. Conclusion-MMTpatients are able to perform the tasks associated with rating scale assessments and standard gamble utility assessments of HCV health states.Practice Implications-These assessment methods should be considered as a means to elicit MMT patients' values for HCV treatment, since the treatment outcome is uncertain but it is likely that side effects will adversely affect current health.

Review of patient-reported outcome measures in chronic hepatitis C

“…Concepts included symptoms and treatment effects related to mental health, physical health, pain, HRQL, activities of daily living (ADL), cognitive dysfunction, and other categories. The most frequently reported CHC-related concepts were: depression [5,6,10,14-30], fatigue [5,6,10,14-26], anxiety/fear [5,6,10,14,17,18,21,22,25,27,28,30,31], musculoskeletal pain/myalgia [6,10,16-18,20,22-24,26], flu-like symptoms [6,10,17,18,23,24,26], irritability [6,16,18,23,29], insomnia or sleep problems [5,6,10,15,18-20,23,24], loss of appetite/anorexia/weight loss [6,10,17,20,23,24], social functioning/isolation/stigma [5,6,10,14-19,22,26-30], gastrointestinal symptoms [5,6,10,17,18,20,24,26], reduced HRQL [5,6,10,14,18,24,32], cognitive impairment [5,10,15,16,20,23,24], and headache [10,18,…”

“…The most commonly reported symptoms were: fatigue [5,6,10,14-26], depression [5,6,10,14-30], anxiety/fear, and inability to function or social consequences of disease [5,6,10,14,17,18,21,22,25,27,28,30]. Other outcomes, including HCV symptoms and side effects of treatment, were: cognitive dysfunction [5,10,15,16,20,23,24], musculoskeletal pain [6,10,16-18,20,22-24,26], gastrointestinal symptoms [5,6,10,17,18,20,24,26], flu-like symptoms [6,10,17,18,23,24,26], dyspnea [18], headache [10,18,20,22,24], reduced functional capacity [6,10,15,18,22,24], reduced quality of life [5,6,10,14,18,24,32], insomnia or sleep problems [5,6,10,15,18-20,23,24], reduced sexual desire [24], loss of appetite, weight loss or anorexia [6,10,17,20,23,24]. …”

“…Psychological consequences were discussed along with a range of emotions, including grief [17], guilt [6], frustration [21], shame [6,27], shock [17,22], denial [6,22], despair [27], embarrassment [26], irritability [6,16,18,23,29], and hostility or anger [6,10,15,17,21-23,25,29]. Other emergent themes included difficulty at work [5,6,10,15,18,24,26], uncertainty or a lack of knowledge about the virus [5,6,10,14,15,17,21,22,28,32], issues related to stigma [5,6,14,15,19,22,27,29,30], and discussion of treatment costs and benefits [6,10,14,18,19,21,23,25,26,28,29,32]. …”