Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease

Mehmet Sayiner, Maria Stepanova, Huong Pham, Bashir Noor, Mercedes Walters, Zobair M Younossi, Mehmet Sayiner, Maria Stepanova, Huong Pham, Bashir Noor, Mercedes Walters, Zobair M Younossi

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease associated with increased liver-related mortality. Additionally, NAFLD could potentially impair health-related quality of life. Although an approved treatment for NAFLD does not exist, a number of new drugs for treatment of NAFLD are being developed. As the efficacy and safety of these regimens are being established, their cost-effectiveness, which requires the use of quality of life metrics and health utility scores to quality-adjusted outcomes, must also be assessed. The aim of this study was to report quality of life and health utilities in patients with NAFLD with and without cirrhosis for future use.

Methods: Patients with NAFLD were seen in an outpatient clinic setting. Each patient had extensive clinical data and completed the Short Form-36 (SF-36 V.1) questionnaire. The SF-6D health utility scores were calculated.

Results: There were 89 patients with the spectrum of NAFLD completed the SF-36 questionnaire: 59 with non-cirrhotic NAFLD and 30 with cirrhosis. Patients with NAFLD had significantly lower quality of life and health utility scores than the general population (all p<0.0001). Furthermore, patients with cirrhosis had lower quality of life and utility scores than non-cirrhotic NAFLD patients: SF-6D 0.660±0.107 in non-cirrhotic NAFLD vs 0.551±0.138 in cirrhotic NAFLD (p=0.0003).

Conclusions: Health utilities and quality of life scores are impaired in patients with cirrhotic NAFLD. These values should be used in cost-effectiveness analysis of the upcoming treatment regimens for advanced NAFLD.

Keywords: CIRRHOSIS; FATTY LIVER; NONALCOHOLIC STEATOHEPATITIS; QUALITY OF LIFE.

Figures

Figure 1
Figure 1
The SF-36 HRQL scores and SF-6D health utilities in patients with cirrhotic and non-cirrhotic NAFLD. Note: The summary scores and the utility scores were transformed to a 0–100 scale for the purpose of presentation. All p

References

    1. Fazel Y, Koenig AB, Sayiner M, et al. . Epidemiology and natural history of non-alcoholic fatty liver disease. Metabolism 2016;65:1017–25.
    1. Golabi P, Sayiner M, Fazel Y, et al. . Current complications and challenges in nonalcoholic steatohepatitis screening and diagnosis. Expert Rev Gastroenterol Hepatol 2015;10:63–71.
    1. Chalasani N, Younossi Z, Lavine JE, et al. . The diagnosis and management of non-alcoholic fatty liver disease: practice Guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology 2012;55:2005–23.
    1. Younossi ZM, Koenig AB, Abdelatif D, et al. . Global epidemiology of non-alcoholic fatty liver disease—meta-analytic assessment of prevalence, incidence and outcomes. Hepatology 2016;64: 73–84.
    1. Golabi P, Otgonsuren M, Cable R, et al. . Non-alcoholic fatty liver disease (NAFLD) is associated with impairment of health-related quality of life (HRQOL). Health Qual Life Outcomes 2016;14:18
    1. Loria A, Escheik C, Gerber NL, et al. . Quality of life in cirrhosis. Curr Gastroenterol Rep 2013;15:301
    1. Younossi Z, Henry L. Contribution of alcoholic and non-alcoholic fatty liver disease to the burden of liver-related morbidity and mortality. Gastroenterology 2016;150:1778–85.
    1. Younossi ZM, Henry L. Economic and quality-of-life implications of non-alcoholic fatty liver disease. Pharmacoeconomics 2015;33:1245–53.
    1. Younossi ZM, Zheng L, Stepanova M, et al. . Trends in outpatient resource utilizations and outcomes for Medicare beneficiaries with nonalcoholic fatty liver disease. J Clin Gastroenterol 2015;49:222–7.
    1. Ghamar Chehreh ME, Vahedi M, Pourhoseingholi MA, et al. . Estimation of diagnosis and treatment costs of non-alcoholic fatty liver disease: a two-year observation. Hepat Mon 2013;13:e7382
    1. Baumeister SE, Volzke H, Marschall P, et al. . Impact of fatty liver disease on health care utilization and costs in a general population: a 5-year observation. Gastroenterology 2008;134:85–94.
    1. Neumann PJ, Goldie SJ, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu Rev Public Health 2000;21:587–611.
    1. Sassi F. Calculating QALYs, comparing QALY and DALY calculations. Health Policy Plan 2006;21:402–8.
    1. Siegel JE, Weinstein MC, Russell LB, et al. . Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA 1996;276:1339–41.
    1. Richardson J, Iezzi A, Khan MA, et al. . Measuring the sensitivity and construct validity of 6 utility instruments in 7 disease areas. Med Decis Making 2016;36:147–59.
    1. Busija L, Pausenberger E, Haines TP, et al. . Adult measures of general health and health-related quality of life: Medical Outcomes Study Short Form 36-Item (SF-36) and Short Form 12-Item (SF-12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF-6D), Health Utilities Index Mark 3 (HUI3), Quality of Well-Being Scale (QWB), and Assessment of Quality of Life (AQoL). Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S383–412.
    1. Stepanova M, Nader F, Cure S, et al. . Patients’ preferences and health utility assessment with SF-6D and EQ-5D in patients with chronic hepatitis C treated with sofosbuvir regimens. Aliment Pharmacol Ther 2014;40:676–85.
    1. Kharroubi SA, Brazier JE, Roberts J, et al. . Modelling SF-6D health state preference data using a nonparametric Bayesian method. J Health Econ 2007;26:597–612.
    1. Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol 1998;51:903–12.
    1. Ara R, Brazier J. Predicting the short form-6D preference-based index using the eight mean short form-36 health dimension scores: estimating preference-based health-related utilities when patient level data are not available. Value Health 2009;12:346–53.
    1. Ware J, Snow K, Kosinski M, et al. . SF-36 health survey manual and interpretation guide. Boston, MA: New England Medical Center, The Health Institute, 1993.
    1. Fryback DG, Dunham NC, Palta M, et al. . US norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Med Care 2007;45:1162–70.
    1. Mishra A, Younossi ZM. Epidemiology and natural history of non-alcoholic fatty liver disease. J Clin Exp Hepatol 2012;2:135–44.
    1. Everhart JE, Ruhl CE. Burden of digestive diseases in the United States Part III: liver, biliary tract, and pancreas. Gastroenterology 2009;136:1134–44.
    1. Younossi ZM, Zheng L, Stepanova M, et al. . Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study. BMJ Open 2014;4:e004318
    1. David K, Kowdley KV, Unalp A, et al. . Quality of life in adults with nonalcoholic fatty liver disease: baseline data from the nonalcoholic steatohepatitis clinical research network. Hepatology 2009;49:1904–12.
    1. Afendy A, Kallman JB, Stepanova M, et al. . Predictors of health-related quality of life in patients with chronic liver disease. Aliment Pharmacol Ther 2009;30:469–76.
    1. Dan AA, Kallman JB, Wheeler A, et al. . Health-related quality of life in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2007;26:815–20.
    1. 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;96:2199–205.

Source: PubMed

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