Patient’s preferences for health scenarios associated with hepatitis C and its treatment

Figures & data

Table 1 Baseline characteristics of 45 enrolled patients

Age	52 ± 12
Sex male	30 (67%)
Risk factors
– Transfusion	5 (11%)
– IDU	0
– Unknown	40 (89%)
Education level
– Elementary school	17 (37%)
– High school	17 (37%)
– University or college	7 (15%)
– Professional/graduate	4 (9%)
Employment status
– Full time	29 (64%)
– Part-time	9 (20%)
– Not employed	6 (13%)
– Retired	1 (2%)
Co-morbidity
– Diabetes	10 (22%)
– Hypertension	10 (22%)
– Hypothyroidism	2 (4%)
– Other	4 (9%)
Naïve	33 (74%)
Previous treatment	12 (26%)
Histology
– Cirrhosis	14 (31%)
Biochemical/virological parameters
– Hb	15 (1.2)
– WBC	6,300 (1,682)
– PLT	194,911 (58,032)
– ALT × UNL	2.5 (1.8)
Virological parameters
– HCV viremia (UI/ml)*	586790 (19,110–6,534,500)
– Genotype 1–4	37 (82%)
– Genotype 2–3	8 (18%)

Note:

* Bayer (median and range).

Abbreviations: ALT, alanine aminotransferase; IDU, intrauterine device; HCV, hepatitis C virus; PLT, platelet; UNL, upper normal limit; WBC, white blood cells.

Figure 1 Assessments of health status and decision-making role.

Figure 2 Box plots of preference values for HCV disease outcomes assessed by visual analog score.

Abbreviation: CH, chronic hepatitis; CIRR, cirrhosis; HCV, hepatitis C virus.

Figure 3 Box plots of preference values for HCV treatment’ outcomes assessed by visual analog score.

Figure 4 Box plots of patient’ estimates of benefit to recommend antiviral treatment.

Table 2 Assessment of decision-making role by CPS

Patient alone	0
Patient primarily	7 (15%)
Shared equally	12 (27%)
Doctor primarily	13 (29%)
Doctor alone	13 (29%)

Abbreviation:c Ps, control preferences scale.

Table 3 Patient’s utilities of health states with HCV by rating scale method

	Cotler and colleagues^Citation15	Chong and colleagues^Citation23	Sherman and colleagues^Citation24
HCV infection, no symptoms	0.89 (0.79–0.94)^	0.68 (0.60–0.77)§
Chronic hepatitis, mild symptoms	0.71 (0.54–0.83)^	0.70 (0.63–0.76)	0.67 ± 0.03°
Cirrhosis, mild symptoms (compensated)	0.44 (0.30–0.60)^	0.65 (0.56–0.73)	0.65 ± 0.04
Cirrhosis, decompensated	0.27 (0.16–0.46)^	0.57 (0.40–0.73)
SVR	ne	0.74 (0.68–0.81)

Notes:

^ Median and range;

§ Mean and 95% CI;

° Mean ± SE.

Abbreviations: CI, confidence interval; HCV, hepatitis C virus; SE, standard error; SVR, sustained virulogical response.

Appendix 1 Decision-making role by control preferences scale

Which of the following is closest to your feeling about the role you feel you should have in your medical decision about treatment of chronic hepatitis C? I would prefer to make the final decision about which treatment I will receive on the basis of the facts I learn from my physician’s opinion I would prefer to make the final decision about my treatment after considering my physician’s opinion I would prefer that my physician and I share responsibility for deciding which treatment is best for me I would prefer that my physician make the final decision about which treatment will be used but he or she seriously consider my opinion I would prefer to leave all decisions regarding treatment to my physician

Appendix 2 Description of six scenarios of health with HCV (Cotler, modified)

1. Asymptomatic chronic hepatitis, no cirrhosis

Absence of symptoms

Transmission to sexual partner possible

May progress to cirrhosis

2. Symptomatic chronic hepatitis, no cirrhosis

Sometimes do not feel rested

Tire more easily than usual

Limitation of physical activity possible

Transmission to sexual partner possible

May progress to cirrhosis

3. Chronic hepatitis with cirrhosis, mild symptoms

Sometimes do not feel rested

Tire more easily than usual

Limitation of physical activity possible

Transmission to sexual partner possible

Have cirrhosis

May get liver cancer

May get liver failure

4. Cirrhosis, moderate to severe symptoms

Usually feel tired

Tire more easily than usual

Limitation of physical activity possible

Little interest in sex

Have cirrhosis

May get liver cancer

May get liver failure

May need liver transplantation

5. Side effects from pegylated interferon and ribavirin

Needle stick one time a week

Pills twice daily

Flu-like symptoms (fever, chills, nausea, headache, poor appetite) that tend to improve after 2 weeks

Tiredness, difficulty in sleeping, irritability, difficulty in concentrating

Chance of other non life-threatening problems that go away after treatment is completed, such as low blood count, hair loss and depression

6. Sustained response to treatment

Absence of symptoms

Transmission to sexual partner unlikely

Progression to cirrhosis very likely reduced

CotlerSJPatilRMcNuttRAPatient’s values for health states associated with hepatitis C and physicians’ estimates of those valuesAm J Gastroenterol2001962730273611569703

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ChongCAGulamHusseinAHeathcoteJEHealth state utilities and quality of life in hepatitis C patientsAm J Gastroenterol20039863063812650799

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ShermanKEShermanSNChenierTHealth values of patients with chronic hepatitis C infectionArch Intern Med20041642377238215557419

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