Original article
Patient health utility, work productivity, and lifestyle impairment in chronic hepatitis C patients in France

https://doi.org/10.1016/j.clinre.2014.10.013Get rights and content

Summary

Background

France has a high prevalence of patients with chronic hepatitis C virus (HCV). Clinical consequences of HCV are well-recognized, while health-related quality of life (HRQoL) and productivity impacts remain less understood. This study evaluates how HCV disease severity and HCV treatment outcomes impact HRQoL and productivity among patients in France.

Methods

From October 2012 to January 2013, physicians treating HCV patients in France completed Patient Record Forms, which included information on patient demographics, disease stage, and treatment status. Subsequently, these HCV patients completed the EQ-5D-3L health-state instrument and the HCV-specific Work Productivity and Activity Impairment (WPAI:HepC) Questionnaire. Results are reported in descriptive and stratified analyses by disease stage and treatment status. Linear regression analyses were performed to determine independent associations between disease severity and treatment status with EQ-5D and WPAI:HepC.

Results

There were 297 matched physician and patient response forms completed. Mean EQ-5D Index score was 0.764, and mean EQ-VAS score was 65.85. Regression analyses showed that older age and worse disease severity were significantly associated with lower EQ-5D Index and EQ-VAS scores. Stratification of EQ-5D Index and EQ-VAS scores showed significantly better scores for HCV treatment responders compared to non-responders. Stratification of WPAI:HepC questions by disease stage revealed greater productivity impact on HCV patients with more severe disease.

Conclusions

In a cross-sectional sample of HCV patients in France, worsening HRQoL and productivity/activity impairment was significantly associated with disease progression and increasing age. This information provides insight into the benefits of treating HCV patients and preventing disease progression.

Introduction

Chronic hepatitis C (HCV) is a growing public health concern, with up to 3% of the population infected and an estimated 360,000 HCV-related deaths each year, worldwide [1]. Within the World Health Organization (WHO) European region, approximately nine million people are chronically infected with HCV [2]. In France, HCV prevalence is estimated at 0.84% (approximately 550,000 citizens) [3], and HCV is responsible for approximately 11.5 deaths per 100,000 residents annually [4]. HCV disease progression can occur over a 20–50-year period [5]; long-term sequelae of chronic infection may include cirrhosis, liver decompensation, hepatocellular carcinoma (HCC), and the need for liver transplantation [6], [7]. In France, cases of cirrhosis and its complications are increasing and are predicted to peak in 2021 [8].

HCV infection causes fatigue, muscle and joint pain, depression, and other psychological disorders, which reduce patient health-related quality of life (HRQoL) and health utility [9], [10]. The decrements in health utility have been linked to severity of liver disease, with the lowest scores seen in patients with decompensated cirrhosis or HCC [9], [11], [12], [13]. HCV treatment is also associated with decreased HRQoL [14]. Despite some advances in the treatment of HCV, interferon (IFN) is still a component of therapy. Administration of current IFN-containing regimens for treatment of chronic HCV infection is challenging due to side effects such as anaemia, depression, flu-like symptoms, neuropsychiatric disorders, neutropenia, and rash, which negatively impact HRQoL and health utility of patients on treatment [15], [16], [17]. Sustained virologic response (SVR) with IFN-based therapy may result in improvements in HRQoL and health utility after treatment is completed [17], [18].

Direct costs associated with HCV are substantial [19]. Additionally, indirect economic and humanistic costs are significant and arise from the reduction of HRQoL owing to both the disease and current HCV treatments; this impacts patient work, daily activities, and lifestyle [15], [20], [21].

To fully characterize the impact of HCV and the burden of disease progression, the negative effects of HCV on worker productivity and patients’ lifestyle need to be understood. In France, there is a lack of studies quantifying HCV patient health utility, worker productivity decrement, and lifestyle impairment. Such data can be used to identify the real costs and benefits of treating HCV patients and preventing disease progression, and are important for accurately capturing the true burden of HCV disease. This information will help define future economic implications associated with HCV and inform public health strategy in France.

The primary objectives of this study were to evaluate HCV patient-reported health utility, defined as a measure of a patient's preference for a specific level of health status, and worker productivity (absenteeism, presenteeism, overall work productivity and activity impairment) in France by disease stage and treatment status. The secondary objectives were to determine the characteristics associated with lower health utility and reduced productivity among HCV patients in France and understand the effects of HCV on lifestyle.

Section snippets

Data collection

Data were obtained from the Adelphi Real World Hepatitis C Disease Specific Programme® (DSP) in France. This was part of a cross-sectional, multi-sponsor survey developed to collect marketing and health outcomes information from the United States and 5 European markets (France, Germany, Italy, Spain and the United Kingdom). The study was run according to EphMRA Market Research Guidelines. Ethical approval was not necessary; however, patient consent to take part was required as information was

Results

Sixty physicians were recruited in France. PRFs were completed for 597 patients. Of these, 297 completed corresponding PSC forms. These were included in the final analysis. Of the 60 physicians participating in the study, 13 (21.7%) described themselves as hepatologists, 25 (41.7%) as gastroenterologists, 13 (21.7%) as infectious disease specialists, and 9 (15.0%) as hepatogastroenterologists. The majority of physicians had a hospital practice (66.7%), while 5 (8.3%) had an office practice, and

Discussion

Patients with HCV report reduced HRQoL in comparison to the general population [9], [10]. This information is necessary to understand the true costs and benefits of treating patients and preventing disease progression, as innovative and highly effective treatments may alleviate HCV-related work impairment, lower the use of healthcare resources, and provide improved HRQoL to infected individuals [21].

This study used a cross-sectional survey of HCV patients in France to quantify patient health

Disclosure of interest

Jennifer C. Samp and Robert W. Baran are AbbVie employees and may hold AbbVie stock or options.

Richard Perry, James Piercy, and Robert Wood are employees of Adelphi Real World and served as consultants to AbbVie.

Funding: The design, analysis, and financial support of this study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the presentation. The data from the Hepatitis C Disease Specific Programme® were sourced from a multi-sponsored survey

Acknowledgements

Jane Kondejewski of SNELL Medical Communication Inc. provided assistance in the writing and preparation of this manuscript; this support was funded by AbbVie. The authors retained full editorial control of the manuscript content.

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