Health Values of Patients With Chronic Hepatitis C Infection

Sherman, Kenneth E.; Sherman, Susan N.; Chenier, Thomas C.; Tsevat, Joel

doi:10.1001/archinte.164.21.2377

Cited by 52 publications

(49 citation statements)

References 26 publications

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“…QALYs are derived from utility loss estimates from five studies based on HCV states F0‐1, F2‐3, CC, DC, HCC, postliver transplant, and post‐SVR 17, 18, 19, 20, 21, 22. QALYs are calculated by multiplying annual stage utility losses by expected background utility based on age for each year of life 23…”

Section: Methodsmentioning

confidence: 99%

Potential epidemiologic, economic, and budgetary impacts of current rates of hepatitis C treatment in medicare and non‐medicare populations

Wittenborn

Brady

Dougherty

et al. 2017

Hepatology Communications

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We forecast the health and budgetary impact of hepatitis C (HCV) treatment on the Medicare program based on currently observed rates of treatment among Medicare and non‐Medicare patients and identify the impact of higher rates of treatment among non‐Medicare populations. We developed a computer microsimulation model to conduct an epidemiologic forecast, a budgetary impact analysis, and a cost‐effectiveness analysis of the treatment of HCV based on three scenarios: 1) no treatment, 2) continuation of current‐treatment rates, and 3) treatment rates among non‐Medicare patients increased to match that of Medicare patients. The simulated population is based on National Health and Nutrition Examination Survey data. HCV progression rates and costs were calculated in Surveillance, Epidemiology, and End Results Program Medicare 5% claims data from the Chronic Hepatitis Cohort Study and published literature. We estimate that 13.6% of patients with HCV in the United States are enrolled in Medicare, but 75% will enter Medicare in the next 20 years. Medicare patients were over 5 times as likely to be treated in 2014‐2015 as other patients. Medicare paid over $9 billion in treatment costs in both 2015 and 2016 and will total $28.4 billion from 2017‐2026. Increasing treatment rates among non‐Medicare patients would lead to 234,000 more patients being treated, reduce HCV mortality by 19%, and decrease Medicare costs by $18.6 billion from 2017‐2026. We find that treatment remains cost‐effective under most assumptions, costing $31,718 per quality adjusted life year gained. Conclusion: Medicare treats a disproportionately large share of HCV patients. Continued low rates of treatment among non‐Medicare HCV patients will result in both reduced and deferred treatment, shifting future treatment costs to Medicare while increasing overall medical management costs, morbidity, and mortality. (Hepatology Communications 2017;1:99‐109)

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Section: Methodsmentioning

confidence: 99%

Potential epidemiologic, economic, and budgetary impacts of current rates of hepatitis C treatment in medicare and non‐medicare populations

Wittenborn

Brady

Dougherty

et al. 2017

Hepatology Communications

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“…Assessments were followed by an audio taped, think-aloud interview where subjects were asked to describe how they formed their responses (Appendix 1). Current health assessments were followed by assessments of four hypothetical health states derived from the literature [13,14,22], representing mild and moderate chronic HCV symptoms and moderate and severe HCV treatment-induced side effects (Appendix 2). Subjects were reminded by the interviewer of their previous responses for current and hypothetical health states and asked if their current answer was accurate in comparison.…”

Section: Methodsmentioning

confidence: 99%

“…It is important to consider utility values from the perspective of HCV patients, because there can be differences between utility values for HCV health states collected from patients versus providers [11][12][13][14][15][16]. Several factors associated with MMT patients, such as non-fatal overdoses, increased likelihood of head injuries, concurrent alcohol dependence, and methadone treatment itself have led some researchers to suggest that MMT patients as a group are cognitively impaired on a range of measures that could adversely impact their ability to perform the tasks associated with these assessments [17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Can urban methadone patients complete health utility assessments?

Teixeira

Schackman

2008

Patient Education and Counseling

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Objective-To assess the ability of methadone maintenance treatment (MMT) patients to use two standardized health assessment tools to value health states related to chronic hepatitis C virus (HCV) infection and HCV treatment-associated side effects. An estimated 65-90% of MMT patients are chronically infected with HCV.Methods-We employed qualitative methods to explore how patients completed computerized rating scale assessments and standard gamble utility assessments by 1) having them discuss their responses in a think-aloud interview immediately after each health state assessment, and 2) allowing them the opportunity to recalibrate prior responses after considering subsequent health states.Results-MMT patients used the rating scale boundaries appropriately and used the standard gamble to rank the health states in an a priori logical order. A guided assessment approach that allowed recalibration provided additional insight into values assigned to the health states presented. Conclusion-MMTpatients are able to perform the tasks associated with rating scale assessments and standard gamble utility assessments of HCV health states.Practice Implications-These assessment methods should be considered as a means to elicit MMT patients' values for HCV treatment, since the treatment outcome is uncertain but it is likely that side effects will adversely affect current health.

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“…Some studies however, show that psychiatric diagnosis is common among transplant candidates specially in patients with previous alcoholic liver disease and hepatitis C carriers who may have worse clinical outcome after transplantation (Sherman, 2004).…”

Section: The Importance Of Psychological Aspectsmentioning

confidence: 99%