HEALTH STATE UTILITIES AND THE EFFECT OF PROFESSIONAL TREATMENT IN GASTROESOPHAGEAL REFLUX DISEASE WITH AND WITHOUT BARRETT'S ESOPHAGUS POPULATION IN CANADA

Saturday, January 9, 2016
Foyer, G/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Hla-Hla Thein, MD, MPH, PhD, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Wanrudee Isaranuwatchai, PhD, Centre for Excellence in Economic Analysis Research, The HUB, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada, Ayaz Hyder, PhD, Ohio State University, Columbus, OH, Natalie Au, Western University, London, Ontario, London, ON, Canada, Murray D Krahn, MD, MSc, FRCPC, Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada, Norman Marcon, MD, FRCP(C), Department of Medicine, University of Toronto, Toronto, ON, Canada, Craig Earle, MD, MSc, FRCP(C), Cancer Care Ontario and the Ontario Institute for Cancer Research and Institute for Clinical Evaluative Sciences, Toronto, ON, Canada and Lincoln Stein, MD, PhD, Ontario Institute for Cancer Research, Toronto, ON, Canada
Purpose: Gastroesophageal reflux disease (GERD) is a common condition that affects patients’ health-related quality of life (HRQoL), and has been shown to worsen HRQoL than patients with Barrett’s esophagus (BE). We aimed to estimate health state utilities in the Canadian GERD population, both with and without BE, and to explore the effect of receiving professional treatment on HRQoL.

Method(s): A community-based cross-sectional on-line survey of patients diagnosed with GERD with and without BE was carried out using EuroQoL 5-Domain (EQ-5D-5L) self-report questionnaire to assess HRQoL and generate utility scores. A generalized linear model was used to determine the impact of professional treatment (i.e., currently receiving treatment, previously received treatment, or never received treatment from a health care professional) on participants’ utility scores, adjusting for sociodemographic and clinical characteristics. 

Result(s): Among GERD patients without BE (n=913), 43.3%, 25.4%, and 31.3% reported currently receiving treatment, previously received treatment, and never received treatment, respectively; the utility scores were 0.78 (95% CI: 0.76-0.79), 0.81 (95% CI: 0.79-0.83), and 0.81 (95% CI: 0.79-0.83), respectively. Among GERD patients with BE (n=78), 41.0%, 30.8%, and 28.2% reported currently receiving treatment, previously received treatment, and never received treatment, respectively; the utility scores were 0.72 (95% CI: 0.60-0.84), 0.73 (95% CI: 0.65-0.81), and 0.75 (95% CI: 0.63-0.87), respectively. In the multivariable analysis, no association was found between HRQoL and professional treatment status as well as BE. Factors associated with lower utility scores were having one or more comorbidities (p<0.001), obesity (BMI 35+, p=0.012), and tobacco use (p=0.041). Canada Atlantic province, being married, postgraduate education, current employment, increasing age at onset of GERD symptoms (60-65 years), and alcohol consumption (majority─50% used alcohol <1 day per week) were associated with higher HRQoL.

Conclusion(s): Our findings demonstrated that GERD patients with and without BE have lower HRQoL compared to the general population in Canada. GERD patients without BE currently receiving health care professional treatment slightly affected HRQoL than those who never received treatment. Our study highlights several factors associated with utility scores among GERD patients with and without BE. The study findings may help to identify challenges in the current health practices and highlight opportunities to improve treatment and implement better screening programs for BE for early detection of esophageal adenocarcinoma and improvement in the burden of disease.

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