The impact of liver diseases (LDs) on health-related quality of life (HRQoL) is an important aspect to understand the burden of these conditions and to improve their management. A well characterized impact of the major LDs on HRQoL of the general population is still lacking. The aim of our study was to fill this gap. A dataset with HRQoL data of a representative sample of the general population of most populated Italian region was matched with the dataset from a multicenter study conducted in the same region and time period to generate and validate a set of health care outcomes indicators for the major LDs (hepatitis B (HBV), hepatitis C (HCV), compensated cirrhosis (CC), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), NAFLD/ NASH and patients listed for liver transplant (LTL)). Within both datasets, HRQoL data were collected using the EQ-5D-3L, a generic instrument that enables HRQoL to be compared within and between clinical conditions and with the general population. It generates a health profile made up of 5 domains (Mobility, Self-care, Usual activities, Pain/discomfort, Anxiety/ depression). It also consists of a visual analogue scale (EQ-5D VAS) which measures overall HRQoL. Further, results from the EQ-5D health profile can be converted to utility index, useful to conduct economic evaluations. Multivariate logistic and linear regressions were then performed adjusting for possible confounders (age, sex, education and working status). A total of 6,800 nullhealthy subjectsnull and 3,105 subjects with LDs (625 HCV, 287 HBV, 614 CC, 531 DC, 647 HCC, 59 LTL, 229 NAFLD/NASH, 68 PBC, 55 PSC, and 49 AIH) were included in the analyses. Multivariate logistic analyses showed that DC, HCC, and LTL had significantly (p<0.05) higher risk to have problems in mobility, self-care, and usual activities compared to nullhealthy subjectednull. AIH had significantly higher risk to have problems in self-care while HCV, CC, DC, and NAFLD/NASH in Anxiety/depression. Similar results were obtained with multivariate linear analyses performed using VAS and Utility-index. DC, HCC, AIH and LTL reported the highest decrease in VAS and Utility score. In conclusion, our results show that HRQoL of asymptomatic liver conditions are comparable to the general population except for the Anxiety/depression dimension. The HRQoL decreased in advanced LDs (DC, HCC, LTL) and AIH. This study provides an actual true estimate of the impact of major LDs on the patients' HRQoL compare to the general population, and therefore is a key tool for decision-making in care delivery for liver diseases.
Cortesi, P., Rota, M., Scalone, L., Cozzolino, P., Cesana, G., Mantovani, L., et al. (2014). The impact of liver disease on the health-related quality of life. HEPATOLOGY, 60(Supplement 1), 948A-949A.
The impact of liver disease on the health-related quality of life
CORTESI, PAOLO ANGELO;ROTA, MATTEO;SCALONE, LUCIANA;CESANA, GIANCARLO;MANTOVANI, LORENZO GIOVANNI;OKOLICSANYI, STEFANO;CIACCIO, ANTONIO;GEMMA, MARTA;Fagiuoli, S;VALSECCHI, MARIA GRAZIA;STRAZZABOSCO, MARIO
2014
Abstract
The impact of liver diseases (LDs) on health-related quality of life (HRQoL) is an important aspect to understand the burden of these conditions and to improve their management. A well characterized impact of the major LDs on HRQoL of the general population is still lacking. The aim of our study was to fill this gap. A dataset with HRQoL data of a representative sample of the general population of most populated Italian region was matched with the dataset from a multicenter study conducted in the same region and time period to generate and validate a set of health care outcomes indicators for the major LDs (hepatitis B (HBV), hepatitis C (HCV), compensated cirrhosis (CC), decompensated cirrhosis (DC), hepatocellular carcinoma (HCC), autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), NAFLD/ NASH and patients listed for liver transplant (LTL)). Within both datasets, HRQoL data were collected using the EQ-5D-3L, a generic instrument that enables HRQoL to be compared within and between clinical conditions and with the general population. It generates a health profile made up of 5 domains (Mobility, Self-care, Usual activities, Pain/discomfort, Anxiety/ depression). It also consists of a visual analogue scale (EQ-5D VAS) which measures overall HRQoL. Further, results from the EQ-5D health profile can be converted to utility index, useful to conduct economic evaluations. Multivariate logistic and linear regressions were then performed adjusting for possible confounders (age, sex, education and working status). A total of 6,800 nullhealthy subjectsnull and 3,105 subjects with LDs (625 HCV, 287 HBV, 614 CC, 531 DC, 647 HCC, 59 LTL, 229 NAFLD/NASH, 68 PBC, 55 PSC, and 49 AIH) were included in the analyses. Multivariate logistic analyses showed that DC, HCC, and LTL had significantly (p<0.05) higher risk to have problems in mobility, self-care, and usual activities compared to nullhealthy subjectednull. AIH had significantly higher risk to have problems in self-care while HCV, CC, DC, and NAFLD/NASH in Anxiety/depression. Similar results were obtained with multivariate linear analyses performed using VAS and Utility-index. DC, HCC, AIH and LTL reported the highest decrease in VAS and Utility score. In conclusion, our results show that HRQoL of asymptomatic liver conditions are comparable to the general population except for the Anxiety/depression dimension. The HRQoL decreased in advanced LDs (DC, HCC, LTL) and AIH. This study provides an actual true estimate of the impact of major LDs on the patients' HRQoL compare to the general population, and therefore is a key tool for decision-making in care delivery for liver diseases.
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