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Monday, 18 October 2004 - 3:15 PM

This presentation is part of: Oral Concurrent Session A - Patient and Physician Behavior/Preferences 1

UTILITY-BASED ASSESSMENTS OF QUALITY OF LIFE IN A RANDOMIZED TRIAL OF ANTIRETROVIRAL THERAPY IN ADVANCED HIV DISEASE

Vilija Joyce, BA1, Sally S. Araki, PhD2, Vandana Sundaram, MPH3, Ariel K. Hill, AB1, Forest Baker, PhD1, Julie Munakata, MS1, Tassos C. Kyriakides, PhD4, Gillian D. Sanders, PhD5, Susan C. Griffin, MSc, BSc6, Mark Holodniy, MD3, Sheldon Brown, MD7, Mark Sculpher, PhD6, Aslam H. Anis, PhD8, Wei Yu, PhD1, Douglas K. Owens, MD, MS3, and the OPTIMA Investigators4. (1) VA Palo Alto Health Care System, Health Economics Resource Center, Menlo Park, CA, (2) Stanford University, Center for Health Policy / Center for Primary Care and Outcomes Research, Stanford, CA, (3) VA Palo Alto Health Care System, AIDS Research Center, Palo Alto, CA, (4) VA Connecticut Health Care System, West Haven Cooperative Studies Program Coordinating Center (CSPCC), West Haven, CT, (5) Duke, Medicine, Durham, NC, (6) University of York, Centre for Health Economics, York, United Kingdom, (7) Bronx VA Medical Center, Infectious Diseases, Bronx, NY, (8) University of British Columbia, Department of Health Care and Epidemiology, Vancouver, BC, Canada

Purpose: Advances in antiretroviral therapy (ART) have dramatically increased survival with HIV. However, the quality of life of patients who have been treated with multiple regimens has not been well studied. We assessed health-related quality of life associated with advanced HIV in patients enrolled in a tri-national ART-management trial.

Methods: The OPTIMA (Options in Management with Antiretrovirals) trial enrolls patients with plasma viral load (pVL) ³ 2,500 copies/mL, a CD4 count £ 300/mm3, and who are currently on ART. We assessed US baseline quality of life assessments (n=1231) for current health using time trade-off (TTO), standard gamble (SG), the Health Utilities Index 2 and 3 (HUI2, HUI3), the EuroQol (EQ-5D), and the visual analog scale (VAS). We stratified patients (n=219) by median pVL (59,614 copies/mL) and CD4 count (128/mm3), and each group’s means were compared using Wilcoxon-Mann-Whitney tests. Correlations and differences across instruments were assessed using Pearson correlation coefficients and Wilcoxon signed rank sum tests.

Results: Baseline mean utilities for US patients, in descending order, were TTO 0.82, SG 0.76, HUI2 0.73, EQ-5D 0.71, VAS 0.68, and HUI3 0.60. The distribution of each instruments’ scores appears to be unimodal with scores concentrated near the healthier end of the scale (suggesting a possible ceiling effect). Mean preferences were generally higher in patients with lower pVL (higher CD4). However, only the EQ-5D and HUI3 revealed a significant difference between patients below and above the median pVL (0.74 vs. 0.67, p=0.02; 0.65 vs. 0.55, p=0.05). Stratified by low and high CD4 count, the EQ-5D yielded the sole significant difference (0.67 vs. 0.74, p=0.05). Correlations between instruments ranged from r=0.09 (SG & HUI2) to r=0.87 (HUI2 & HUI3). All were statistically significant (p £ 0.05) except for one pair (SG & HUI2). All mean utility scores between instruments were significantly different (p £ 0.05), except between SG & HUI2, SG & EQ-5D, and HUI2 & EQ-5D.

Conclusions: Patients with advanced HIV disease who have failed multiple ART regimens have a substantially reduced quality of life as assessed by utility-based instruments. In this group, immunologic status did not strongly influence quality of life. Assessments of quality of life vary significantly among instruments, thus highlighting the importance of the choice of methods used for preference assessment.


See more of Oral Concurrent Session A - Patient and Physician Behavior/Preferences 1
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)