PS2-19 A SYSTEMATIC REVIEW AND META-ANALYSIS OF HEALTH UTILITIES IN CHRONIC HEPATITIS C PATIENTS

Monday, October 24, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS2-19

Yasmin Saeed, BScPhm1, Mohammed Alhokail2, Joanna M. Bielecki, BSc, MISt2, Lusine Abrahamyan, MD, MPH, PhD2, Petros Pechlivanoglou, MSc, PhD3, Murray Krahn, MD, MSc, FRCPC2 and William W. L. Wong, PhD4, (1)Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada, (2)Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada, (3)Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada, (4)School of Pharmacy, University of Waterloo, Kitchener, ON, Canada

Purpose :

 

   To synthesize the health utilities of patients with chronic hepatitis C (CHC) in order to understand the burden of CHC; and for use in economic evaluations of CHC treatments and screening programs to guide funding decisions.

 

Method:

  

   We searched MEDLINE, EMBASE, and the Cochrane Library for studies measuring health utilities in CHC patients using any instrument. The search was limited to English-language papers published from 1989 onward. Results were pooled using meta-analysis for patients with a similar disease severity and treatment status. A meta-regression was used to examine patient and study design factors that contribute to lower utility scores. Since there was no existing tool for evaluating the quality of utility studies, a checklist tool was developed by the systematic review team based on NICE guidelines.

 

Result:

 

   Results of the systematic review, meta-analysis, and meta-regression for studies using the EQ-5D-3L instrument are presented here (full analysis in progress). Sixteen clinical studies with a total of 6,012 patients were included in the meta-analysis (see Table 1). The mean age of patients was 45 years, and 64% were male. Mild/moderate CHC was associated with a mild impairment in quality of life; cirrhosis and hepatocellular carcinoma (HCC) utilities were slightly lower; and decompensated cirrhosis utilities were substantially lower. Being on treatment also lowered utilities, but sustained virologic response (SVR) resulted in higher utilities than mild/moderate CHC.

 

   There was a large degree of heterogeneity between studies in terms of study and patient characteristics. A meta-regression found that randomized controlled trials had higher mean utilities than observational studies (p<0.05).

 

   Limited utility data exist for certain subpopulations of CHC patients, including: decompensated cirrhosis, HCC, and post-transplant patients; patients with comorbidities such as HIV and haemophilia; and socioeconomically marginalized patients.

 

Conclusion:

 

   CHC is associated with a significant impairment in quality of life, particularly in advanced disease. Curative therapy can alleviate this burden.

 

   The large degree of heterogeneity between studies highlights the need to incorporate data from a wide range of studies in economic analyses of CHC screening and treatment, as well as the importance of incorporating the associated uncertainty surrounding these estimates.

 

   This review included a significant amount of new data compared to a previously published meta-analysis (McLernon 2008). However, further research is still needed in certain subgroups of CHC patients.

 

 

 

 

 

 

 

 

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