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QUALITY OF LIFE AND HEALTH VALUES OF INJECTION DRUG USERS WITH CHRONIC HEPATITIS C VIRUS (HCV) INFECTION
A John-Baptiste1, J Grebely3,4, K Genoway3,4, L Gallagher3,4, D Elliot4, M Krahn1,2, B Conway3,4
1Department of Health Policy, Management & Evaluation; 2Faculty of Pharmacy, University of Toronto, Ontario; 3Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia; 4Pender Community Health Centre, Vancouver, British Columbia
Chronic HCV infection can result in cirrhosis, liver failure and death. In North America, more than 70% of new infections occur in injection drug users (IDUs). However, few studies have measured quality of life in IDUs.
AIM: The purpose of this study was to obtain psychometric and utility measures of quality of life in current or former IDUs chronically infected with HCV.
METHODS: Current and former IDUs attending an urban community health clinic in Vancouver, BC were enrolled in a prospective observational study to evaluate treatment of HCV infection. Patients => 18 years old, serum HCV RNA positive, HBsAg negative with biopsy proven chronic liver disease or serum alanine amino-transferase (ALT) levels > 1.5 times the upper limit of normal were included. Patients self-administered the Health Utilities Index (HUI2/3) and the Hepatitis Quality of Life Questionnaire - which includes the Short Form (SF)-36 version 2 and hepatitis specific dimensions - within 4 weeks prior to initiating antiviral therapy. Utilities were calculated from the SF-36 using the SF-6D scoring method. Relationships among instrument scores were assessed using the Pearson correlation coefficient. Mean utilities were compared to Canadian population norms using one-sample t tests.
RESULTS: Overall, 29 subjects (22 males, 7 females) were enrolled. Mean age was 45 years and 30% were on methadone maintenance therapy. Mean SF-36 scores were: physical functioning – 53.0, role physical – 73.0, bodily pain – 56.7, general health perception – 53.7, energy/vitality – 42.9, social functioning – 58.6, role emotional – 66.4, mental health – 69.2, physical component scale (PCS) – 43.1 and mental component scale (MCS) – 42.8), all significantly below Canadian norms. (p-values < 0.03) Mean scores (sd) for hepatitis specific limitations and health distress were 59.5 (34.6) and 56.2 (26.8) respectively. The mean (sd) HUI2, HUI3 and SF6D utilities were 0.78 (0.19), 0.63 (0.30) and 0.64 (0.10). The mean HUI3 utility for healthy Canadians is 0.93. Correlations among the PCS, MCS, HUI2, HUI3 and SF6D ranged from 0.37 to 0.78.
CONCLUSIONS: Similar to non-substance abusing populations with chronic HCV infection, quality of life among HCV infected IDUs is significantly lower than population norms. The relative contribution of addiction and chronic HCV infection is unclear.
Funded by NCRTP-HepC, CLF, CIHR and Health Utilities Incorporated