Some patients with end-stage liver disease (ESLD) can survive without a transplant for many years, but while waiting for a new liver, their quality of life is severely compromised. They are unhappy, suffer from physical and psychological problems, and have difficulty functioning socially and physically, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09694). The 78 ESLD patients studied needed a transplant because of liver failure due to alcoholic liver disease, Hepatitis B or C virus infection, cancer, or other liver diseases.
The researchers measured the quality of life of the ESLD patients prior to liver transplantation at one medical center using questionnaires and face-to-face interviews to assess health status and preference for his or her current health state (utility assessment). Time-tradeoff
utility questions addressed how patients valued their current and possible health states by asking how much time they would trade for a better health state. Standard gamble utility questions asked how much risk they were willing to take for better health. A 70-item liver disease-specific health status questionnaire addressed the number of ESLD-related physical symptoms and associated distress, psychological status, personal function (for example, ability to walk or climb stairs), social and role function, and general health perception.
Patients' health status was generally poor. On a 0 (worst) to 1 (best) scale, their median physical symptoms score was 0.33; psychological symptoms, 0; happiness, 0.50; personal function, 0; social/role function, 0.40; and general health perception, 0.40. The median time tradeoff score was 0.79, indicating that half of the patients chose healthier life in return for a 21 percent shorter life expectancy. The median standard gamble score was .50, indicating that half of the patients were willing to take up to a 50 percent risk of death in exchange for perfect health. Despite the overall consistency between the two approaches in evaluating the quality of life of these patients, for cost-effectiveness analyses, only direct measures of utility can be used to quantify health states, conclude the researchers.
See "Health status versus utilities of patients with end-stage liver disease," by Cindy L. Bryce, Ph.D., Derek C. Angus, M.D., M.P.H., JoAnn Switala, M.P.A., and others, in the May 2004 Quality of Life Research 13, pp. 773-782.
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