Comparison of Health-Related Quality of Life Preferences Between Physicians and Cirrhotic Patients: Implications for Cost–Utility Analyses in Chronic Liver Disease

Abstract

Accurate assessment of utilities to calculate quality-adjusted life expectancy for medical interventions is needed in cirrhosis. To date, limited data exist in cirrhotics and are generally physician-assigned. Therefore, our aim was to determine utilities for six clinical scenarios in cirrhosis and to define if differences exist in utilities assigned by physicians versus patients. We administered a questionnaire to 83 physicians and 114 cirrhotics to obtain utilities using the time trade-off method for (1) compensated cirrhosis, (2) decompensated cirrhosis, (3) encephalopathy, (4) spontaneous bacterial peritonitis, (5) variceal bleeding, and (5) hepatocellular carcinoma. On a scale from 0 (death) to 1 (perfect health), mean utilities of physicians and patients were compared using the Student t test. One-way analysis of variance was used to compare the utilities between patients according to Child-Pugh class. Statistical significance was defined as a P value <0.05. The mean age of the physicians was 42 +/- 11, with 52% being male. The mean age of the patients was 52 +/- 9; with 59% male. The mean Child-Pugh score was 8 +/- 2 and HCV was the most common etiology (54%). The mean utilities for physicians and patients were as follows: CC, 0.78 vs. 0.88; DC, 0.55 vs. 0.74; E, 0.38 vs. 0.55; SBP, 0.33 vs. 0.45; VB, 0.27 vs. 0.40; and HCC, 0.19 vs. 0.30. All comparisons were statistically significant. Although physicians and patients assigned similar relative rankings to each health state, physicians assigned utilities were significantly different from those assigned by patients. These results suggest that studies that have used physician-assigned utilities do not accurately reflect patient preferences.

Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis

“…We were unable to identify any studies that provided utility estimates from patients with HBV or alcoholic cirrhosis. However, in two studies 311,439 of patient-based quality of life for different cirrhotic health states, there were no statistically significant differences in utility between respondents with viral versus non-viral cirrhosis in any of the health states assessed. Therefore, utility estimates were applied from studies of patients with HCV-related cirrhosis to patients with cirrhosis due to HBV and alcohol.…”

Systematic Review: Health-State Utilities in Liver Disease: A Systematic Review

“…Three studies used chronic liver disease patients to estimate utilities, 16, 23, 30 1 used an expert panel, 29 and 1 used both physicians and cirrhotic patients. 31 Again, patients were grouped differently into various Studies which have potential to be included in metaregression or used directly in a study (n = 30)…”

“…42 Utilities for various complications of liver disease were also estimated, including hepatic encephalopathy, ascites, and varices. 9,31,43 Twenty-four of the 30 studies from the appendix were not included in the metaregression. Eighteen were excluded because for each disease state within liver disease groups, there were fewer than 3 studies; 4 were excluded because they did not have enough data to estimate the standard error, 9, 23, 24, 44 1 study used a child population, 37 and 1 study did not calculate an overall EQ-5D value.…”

Quality of life in refractory ascites: Transjugular intrahepatic portal-systemic shunting versus medical therapy

“…15,18,19 Therefore, objective instruments are essential to evaluate any quality-of-life benefit from TIPS. The SF-36 is a general assessment of quality of life not specifically designed for the evaluation of patients with advanced liver disease.…”