Date Published: May 3, 2019
Publisher: Public Library of Science
Author(s): Sabrina Cossais, Michaël Schwarzinger, Stanislas Pol, Hélène Fontaine, Dominique Larrey, Georges-Philippe Pageaux, Valérie Canva, Philippe Mathurin, Yazdan Yazdanpanah, Sylvie Deuffic-Burban, Florian Fischer.
This study evaluated the clinical and non-clinical determinants of health-related quality of life (HRQoL) associated with untreated chronic hepatitis C (CHC) in France.
From 01/2014 to 01/2015, untreated CHC patients were invited to complete a questionnaire including EQ-5D utility instrument and two visual analogue scales (VAS) measuring overall health and fatigue in three French centers (Paris, Lille and Montpellier). Answers were analyzed in mixed models (taking into account the clustering effects of centers and physicians).
Five hundreds and five patients were enrolled: 52% males; the mean age was 54; 41% had BMI>25; 64% had genotype 1; 36% were at the stage of severe fibrosis (F3-F4); 38% had severe comorbidities other than liver-related. In the univariate analysis, EQ-5D utility was associated with socio-demographic variables as age, place of birth, education, and employment; CHC-related variables as conditions of HCV screening and severity of fibrosis; CHC-unrelated variables as comorbidities other than CHC, being overweight, and psychiatric disorders; feelings about CHC disease as perception of progression, lack of information on CHC and its treatments, and entourage’s feeling. In multivariate analysis, EQ-5D utility was affected by not being in employment (0.72 vs. 0.80), having severe comorbidities other than CHC (0.72 vs. 0.79), being overweight (0.73 vs. 0.78), and feeling worried about CHC progression (0.66 vs. 0.72–0.84). Similar results were found for the VAS.
The presence of severe comorbidities and worrying about CHC progression, but not stage of fibrosis, seem to alter significantly EQ-5D health utility in CHC French patients.
The impact of chronic hepatitis C (CHC) infection on health-related quality of life (HRQoL) has received increasing interest over the past ten years [1,2]. HRQoL has been especially shown to be impaired in patients with CHC [3–6]. With the advent of highly effective, and well tolerated, new direct-acting antivirals (DAAs), clinicians and patients emphasize that all those with HCV should receive these new treatments, not only to decrease HCV morbidity and mortality and/or HCV transmission, but also to improve patients’ HRQoL. Indeed, higher HRQoL has been found after a sustained virological response [7,8]. The hypothesis is that, because of the impact of these treatments on HRQoL, and despite their high costs, they could be cost-effective even in those patients who are at the early stages of the disease. However, few studies have measured HRQoL [7,9,10].
This is the first study conducted in France to assess QoL in a large sample of patients affected by CHC. We found that EQ-5D utility values, as well as overall health and fatigue assessed by VAS, were mainly influenced by socio-demographic characteristics (unemployment), by comorbidities (including overweight), and by individual perceptions about CHC progression, rather than by the clinical characteristics of CHC (fibrosis stage, genotype, treatment-naïve status).