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Wednesday, 20 October 2004

This presentation is part of: Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment

HEALTH VALUES OF PATIENTS INFECTED WITH HIV, HEPATITIS C, OR BOTH: ARE TWO VIRUSES WORSE THAN ONE?

Joseph M. Mrus, MD, MSc1, Kenneth E. Sherman, MD, PhD2, Anthony C. Leonard, PHD3, Susan N. Sherman, DPA3, Karen L. Mandell, PharmD3, and Joel Tsevat, MD, MPH1. (1) Cincinnati VA Medical Center and University of Cincinnati, Division of General Internal Medicine and Institute for Health Policy and Health Services Research, Cincinnati, OH, (2) University of Cincinnati, Division of Digestive Diseases, Cincinnati, OH, (3) University of Cincinnati, Institute for Health Policy and Health Services Research, Cincinnati, OH

Purpose: To compare health values of patients coinfected with HIV/hepatitis C (HCV) with those of patients singly infected with HIV or HCV and to assess the relationship of clinical and non-health-related factors to health values. Methods: We interviewed subjects with HIV and/or HCV from Cincinnati and Pittsburgh in 2003 and 2004. We assessed rating scale (RS), time tradeoff (TTO), and standard gamble (SG) utilities using U-Maker (each scaled from 0–1.0), and we explored univariate (Pearson and Spearman correlations) and multivariable (linear regressions) associations of the health values with the Mental Component Summary (MCS, 0-100) and Physical Component Summary (PCS, 0-100) of the SF-12, the number of bothersome symptoms (BS, range 0-15) from the Justice scale, spirituality (SPIR, 0-92) from the FACIT-SpEx as well as a number of demographic, clinical, and psychosocial characteristics collected by interview and chart review. Results: Of the 203 subjects, 59 (29%) had HIV monoinfection, 69 (34%) had HCV monoinfection, and 75 (37%) were coinfected. The mean (SD) age for the cohort was 45.7 (8.3) years; 77% were male; 58% were white; and 42% had a history of injection drug use. Selected results [mean (SD)] by infection type are shown in the table. In multivariable models, RS was significantly associated with sexual orientation, PCS, MCS, BS and SPIR (R2=0.62); TTO with BS and SPIR (R2=0.24); and SG with infection type (HCV moninfection better), PCS, and BS (R2=0.25). Conclusions: Health values of patients with HIV, HCV, or both appear to be driven more by symptoms, function, and spirituality than by infection type or number of infections. Our findings have implications both for Markov modeling of these disease states and for designing possible interventions to improve health values.


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