Year 2019 / Volume 111 / Number 6
Original
Long-term changes on health-related quality of life in patients with chronic hepatitis C after viral clearance with direct-acting antiviral agents

445-452

DOI: 10.17235/reed.2019.6063/2018

Silvia Goñi Esarte, Regina Juanbeltz, Iván Martínez-Baz, Jesús Castilla, Ramón San Miguel, José Ignacio Herrero, José Manuel Zozaya,

Abstract
Background and aim: new direct-acting antivirals (DAAs) achieve high and sustained virological response (SVR) rates, although the long-term effect on patient health-related quality of life (HRQoL) is unknown. This study aimed to evaluate the impact of hepatitis C virus (HCV) clearance with DAAs on HRQoL after one year of follow-up. Methods: this was a prospective observational study of chronic hepatitis C patients who started DAA treatment between May 2016 and April 2017 and completed the EQ-5D-5L questionnaire at baseline, 12 (post-12) and 48 (post-48) weeks after the end of treatment. Patients with SVR were analyzed in order to investigate factors associated with changes in HRQoL. Results: a total of 199 patients were enrolled, 65% were male, 29% had cirrhosis and 32% had HIV co-infection. The proportion of patients with problems in mobility (from 35% to 21%, p = 0.002), usual activities (26% to 11%, p < 0.001), pain/discomfort (60% to 35%, p < 0.001) and anxiety/depression (57% to 35%, p < 0.001) decreased from the baseline to post-48. The median baseline and post-48 EQ-5D utility and visual analogue scale (VAS) score increased from 0.857 to 0.932 (p < 0.001) and from 70.0 to 90.0 (p < 0.001), respectively. HRQoL improvement was observed in all subgroups of patients. According to the multivariate analyses, patients with F2-F4 fibrosis had a higher utility and VAS score improvement at post-48 than F0-F1 patients, and females had a greater improvement in the VAS score. Age ≥ 65 years and HIV co-infection were associated with a lower gain in VAS score (all p < 0.05). Conclusions: hepatitis C virus clearance with DAAs is associated with important long-term improvements in HRQoL. Four of the five EQ-5D-5L dimensions, as well as the utility value and VAS score significantly improved one year after successful treatment with DAAs.
Share Button
New comment
Comments
No comments for this article
References
1. Córdoba J, Flavià M, Jacas C, et al. Quality of life and cognitive function in hepatitis C at different stages of liver disease. J Hepatol. 2003;39(2):231-8.
2. Björnsson E, Verbaan H, Oksanen A, et al. Health-related quality of life in patients with different stages of liver disease induced by hepatitis C. Scand J Gastroenterol. 2009;44(7):878-87.
3. Younossi ZM, Boparai N, Price LL, et al. Health-related quality of life in chronic liver disease: the impact of type and severity of disease. Am J Gastroenterol. 2001;96(7):2199-205.
4. Younossi ZM, Guyatt G, Kiwi M, et al. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut. 1999;45(2):295-300.
5. López Bastida J, Oliva J, Antoñanzas F, et al. [A proposed guideline for economic evaluation of health technologies]. Gac Sanit. 2010;24(2):154-70.
6. Devlin NJ, Parkin D, Browne J. Patient-reported outcome measures in the NHS: new methods for analysing and reporting EQ-5D. Health Econ. 2010;19(8):886-905.
7. Devlin NJ, Brooks E. EQ-5D and the EuroQol Group: Past, Present and Future. Appl Health Econ Health Policy. 2017;15(2):127-137.
8. Devlin NJ, Krabbe PF. The development of new research methods for the evaluation of EQ-5D-5L. Eur J Health Econ. 2013;14(Suppl 1):1-3.
9. EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208.
10. Herdman M, Gudex C, LLoyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727-36.
11. FDA Guidance for Industry. Patient-reported outcome measures: use in medical product development to support labeling claims; 2009. Available at: http://www.fda.gov/downloads/Drugs/Guidances/UCM193282.pdf [accessed 29.07.17].
12. Center for Disease Control and Prevention. Health Related Quality of Life (HRQOL). Available from: https://www.cdc.gov/hrqol/well-being.htm. Accessed September 5, 2017.
13. Orive M, Antón-Ladislao A, González N, et al. New psychometric data from the Spanish versions of the Glasgow Dyspepsia Severity Score and the Dyspepsia-Related Health Scale measures. Rev Esp Enferm Dig. 2018;110(1):10-18.
14. Younossi ZM, Stepanova M, Henry L, et al. Minimal impact of sofosbuvir and ribavirin on health related quality of life in chronic hepatitis C (CH-C). J Hepatol. 2014;60(4):741.7.
15. McHutchinson JG, Ware JE Jr, Bayliss MS, et al. Hepatitis Interventional Therapy Group. The effects of interferon alpha-2b in combination with ribavirin on health related quality of life and work productivity. J Hepatol. 2001;34(1):140-7.
16. Younossi Z, Kallman J, Kincaid J. The effects of HCV infection and management on health-related quality of life. Hepatology. 2007;45(3):806-16.
17. Bonkovsky HL, Woolley JM. Reduction of health-related quality of life in chronic hepatitis and improvement with interferon therapy. The Consensus Interferon Study Group. Hepatology. 1999;29(1):264-70.
18. Bezemer G, Van Gool AR, Verheij-Hart E, et al. Long-term effects of treatment and response in patients with chronic hepatitis C on quality of life. An international, multicenter, randomized, controlled study. BMC Gastroenterol. 2012;12:11.
19. Ware JE, Bayliss MS, Manocchia M, et al. Health-related quality of life in chronic hepatitis C: impact of disease and treatment response. The Interventional Therapy Group. Hepatology. 1999;30(2):550-5.
20. Lam BP, Jeffers T, Younoszai Z, et al. The changing landscape of hepatitis C virus therapy: focus on interferon-free treatment. Therap Adv Gastroenterol. 2015;8(5):298-312.
21. Juanbeltz R, Goñi Esarte S, Úriz-Otano JI, et al. Safety of oral direct acting antiviral regimens for chronic hepatitis C in real life conditions. Postgrad Med. 2017;129(4):476-483.
22. Saeed S, Moodie EEM, Strumpf E, et al. Real-world impact of direct acting antiviral therapy on health-related quality of life in HIV/Hepatitis C co-infected individuals. J Viral Hepat. 2018. doi: 10.1111/jvh.12985. [Epub ahead of print]
23. Younossi ZM, Stepanova M, Henry L, et al. Adherence to treatment of chronic hepatitis C: from interferon containing regimens to interferon and ribavirin free regimens. Medicine (Baltimore). 2016;95(28):e4151.
24. Younossi ZM, Stepanova M, Reddy R, et al. Viral eradication is required for sustained improvement of patient-reported outcomes in patients with hepatitis C. Liver Int. 2018. doi: 10.1111/liv.13900. [Epub ahead of print].
25. Juanbeltz R, Martínez-Baz I, San Miguel R, et al. Impact of successful treatment with direct-acting antiviral agents on health-related quality of life in chronic hepatitis C patients. PLoS One 2018;13(10): e0205277.
26. Marcellin F, Roux P, Protopopescu C, et al. Patient-reported outcomes with direct-acting antivirals for the treatment of chronic hepatitis C: current knowledge and outstanding issues. Expert Rev Gastroenterol Hepatol. 2017;11(3):259-68.
27. Scalone L, Ciampichini R, Fagiuoli S, et al. Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D-5L in patients with chronic hepatic diseases. Qual Life Res. 2013;22(7):1707-16.
28. EuroQol Group [internet]. [cited 2018 Aug 29]. Available from: https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/valuation-standard-value-sets/crosswalk-index-value-calculator/
29. Secretaría General de Sanidad y Consumo. Plan estratégico para el abordaje de la hepatitis C en el sistema nacional de salud. Ministerio de Sanidad, Servicios Sociales y Consumo; 2015. Available at: https://www.msssi.gob.es/ciudadanos/enfLesiones/enfTransmisibles/docs/plan_estrategico_hepatitis_C. pdf Accessed 01/03/2018.
30. Younossi ZM, Stepanova M, Nader F, et al. Patient-reported outcomes in chronic hepatitis C patients with cirrhosis treated with sofosbuvir-containing regimens. Hepatol. 2014;59(6):2161-9.
31. Mar J, Ibarrondo O, Martínez-Baz I, et al. Economic evaluation of a population strategy for the treatment of chronic hepatitis C with direct-acting antivirals. Rev Esp Enferm Dig. 2018;110(10):621-628.
32. Ragusa R, Bertino G, Bruno A, et al. Evaluation of health status in patients with hepatitis c treated with and without interferon. Health Qual Life Outcomes. 2018;16(1):17.
Related articles

Editorial

Cases of liver disease lost in the health system: a call to action

DOI: 10.17235/reed.2021.8316/2021

Original

Active search for hepatitis C patients in primary care

DOI: 10.17235/reed.2021.8067/2021

Original

Hepatitis C in homeless people: reaching a hard-to-reach population

DOI: 10.17235/reed.2021.7737/2020

Editorial

Screening guide for hepatitis C virus infection in Spain

DOI: 10.17235/reed.2020.7728/2020

Special Article

Strategy for the Elimination of Hepatitis C in Cantabria

DOI: 10.17235/reed.2020.7108/2020

Editorial

Reflex testing. A key tool for the elimination of hepatitis C

DOI: 10.17235/reed.2020.7201/2020

Original

Quality of life study in asymptomatic patients with hepatitis C

DOI: 10.17235/reed.2019.6339/2019

Letter

Acute seronegative hepatitis C: two case reports

DOI: 10.17235/reed.2019.5921/2018

Citation tools
Goñi Esarte S, Juanbeltz R, Martínez-Baz I, Castilla J, San Miguel R, Herrero J, et all. Long-term changes on health-related quality of life in patients with chronic hepatitis C after viral clearance with direct-acting antiviral agents. 6063/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 467 visits.
This article has been downloaded 253 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 24/11/2018

Accepted: 24/12/2018

Online First: 08/05/2019

Published: 07/06/2019

Article revision time: 28 days

Article Online First time: 165 days

Article editing time: 195 days


Share
This article has been rated by 1 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology