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Quality-of-Life Tradeoffs for Hepatitis C Treatment: Do Patients and Providers Agree?

Author

Listed:
  • Bruce R. Schackman

    (Department of Public Health, Weill Medical College of Cornell University, brs2006@med.cornell.edu)

  • Paul A. Teixeira

    (Department of Public Health, Weill Medical College of Cornell University)

  • Gil Weitzman

    (Department of Medicine, Division of Gastroenterology and Hepatology and the Center for the Study of Hepatitis C Weill Medical College of Cornell University, New York)

  • Alvin I. Mushlin

    (Department of Public Health, Weill Medical College of Cornell University)

  • Ira M. Jacobson

    (Department of Medicine, Division of Gastroenterology and Hepatology and the Center for the Study of Hepatitis C Weill Medical College of Cornell University, New York)

Abstract

Background . Chronic hepatitis C (HCV) treatment is initiated infrequently by patients in urban settings. These patients often decline HCV treatment due to concerns about treatment side effects and have communication problems with their physicians. Methods . The authors investigated differences between how patients and providers evaluate the quality-of-life tradeoffs associated with HCV treatment in computer-assisted interviews. They interviewed 92 treatment-naive HCV patients at gastroenterology, methadone maintenance, and HIV clinics at 3 hospitals in New York City and 23 physicians or nurses experienced in treating HCV at other hospitals in New York City. Subjects completed rating scale and standard gamble evaluations of current health and hypothetical descriptions of HCV symptoms and treatment side effects on a scale from 0 (death or worse than death) to 1 (best possible health). Results . Treatment side effects were rated worse by patients than providers using the rating scale (moderate side effects 0.42 v. 0.62; severe side effects 0.24 v. 0.40) and standard gamble (moderate side effects 0.61 v. 0.91; severe side effects 0.52 v. 0.75) (all P ≤ 0.01 ). A year of severe side effects was equivalent to 4.1 years of mild HCV symptoms avoided for patients if they returned to their current health after treatment compared with 2.0 years avoided if they achieved average population health. For patients with depression symptoms, HCV treatment with severe side effects had lower value unless it would also improve their current health. Conclusions . Patients have more concerns about treatment side effects than providers. Further research is warranted to develop HCV decision aids that elicit patient preferences and to evaluate how improved communication of the risks and benefits of HCV treatment and more effective treatment of depression may alter these preferences.

Suggested Citation

  • Bruce R. Schackman & Paul A. Teixeira & Gil Weitzman & Alvin I. Mushlin & Ira M. Jacobson, 2008. "Quality-of-Life Tradeoffs for Hepatitis C Treatment: Do Patients and Providers Agree?," Medical Decision Making, , vol. 28(2), pages 233-242, March.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:2:p:233-242
    DOI: 10.1177/0272989X07311753
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    Citations

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    Cited by:

    1. Teresa Kauf & Ateesha Mohamed & A. Hauber & Derek Fetzer & Atiya Ahmad, 2012. "Patients’ Willingness to Accept the Risks and Benefits of New Treatments for Chronic Hepatitis C Virus Infection," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(4), pages 265-278, December.
    2. Benjamin P Linas & Devra M Barter & Jared A Leff & Sabrina A Assoumou & Joshua A Salomon & Milton C Weinstein & Arthur Y Kim & Bruce R Schackman, 2014. "The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-11, May.

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