HEALTH UTILITIES IN MARGINALIZED CHRONIC HEPATITIS C PATIENTS PARTICIPATING IN A COMMUNITY-BASED HEPATITIS C PROGRAM
To obtain health utilities from chronic hepatitis C (CHC) patients participating in a community-based hepatitis C program who are experiencing significant social and economic marginalization. This population has previously been underrepresented in utility studies and economic analyses.
In this ongoing pilot study, we are measuring the health utilities of 129 CHC patients participating in the Toronto Community Hepatitis C Program (TCHCP) at three community health centres in Toronto, Ontario from February to October, 2015.
The TCHCP is a unique community-based interprofessional program aimed at providing hepatitis C treatment, support, and education to individuals who have difficulty accessing mainstream (e.g. hospital-based) healthcare due to barriers such as past or current homelessness, low income, alcohol and/or drug use, and mental health issues.
Each patient is being asked to complete the EuroQol-5D (EQ-5D) and Health Utilities Index Mark 2/3 (HUI2/HUI3) as well as provide demographic and clinical information.
Preliminary data have been collected from 68 patients to date. Most patients reported a history of injection drug use. The mean (standard error) utilities were: EQ-5D=0.701 (0.026); HUI2=0.709 (0.025); and HUI3=0.528 (0.040).
Utilities were also estimated separately for different subpopulations based on severity of liver disease. A regression model was formulated to assess the effects of socio-demographic and clinical variables on utilities.
Our preliminary results suggest that marginalized CHC patients have lower utilities than those previously reported in the literature for CHC patients. For example, a 2008 systematic review by McLernon et al. found mean utilities of: EQ-5D=0.747; HUI2=0.823; and HUI3=0.741 for patients with moderate CHC.
This disparity is likely due to the fact that previous utility studies have been conducted in tertiary care settings which serve primarily middle-class patients and are less likely to be accessed by patients from disadvantaged socioeconomic backgrounds. This is a major limitation because marginalized patients, including those who use intravenous drugs, comprise a large body of CHC patients.
With many promising but costly new treatments recently becoming available for CHC, it will be important to evaluate their cost-effectiveness with the inclusion of this previously underrepresented patient demographic. Our findings will increase the accuracy of economic evaluations of hepatitis C screening and treatment by providing utility data that is more reflective of the affected population.