A Systematic Review Assessing the Impact of Chronic Hepatitis C on Health-Related Quality of Life and Patient-Reported Outcomes

Abstract

Introduction: Chronic Hepatitis (CH-C) and its treatment negatively impacts health-related quality of life (HRQL) and other patient-reported outcomes (PROs). We performed a systematic review to assess the impact of CH-C and its treatments on HRQL. Methods: Databases (Ovid MEDLINE, PubMed, CINAHL,PsycInfo, Social Sciences Citation Index, Social Sciences Abstracts, Social Work Abstracts, and Academic Search Complete) were searched for 2004-May 2014 using a combination of MEsh, thesaurus terms, and relevant text words: hepatitis C, chronic hepatitis C, quality of life, fatigue, work productivity, absenteeism, return to work, work, work capacity evaluation, and employment. After exclusion criteria (studies not in English or patients coinfected with HIV and/or hep B and/or having an active malignancy), 439 articles were obtained. Further exclusion criteria (use of non-validated HRQL questionnaires and/or data not published in a peer review journal) were applied by 2 data collectors. Each article was assessed for quality and results were summarized. Results: After exclusion criteria, 73 articles remained (61 HRQL, 20 fatigue, and 3 work productivity questionnaires). The most common HCV treatment was interferon alpha-2b (IFN) with ribivarin (RBV) (41%). The most common questionnaires were: SF-36 and CLDQ-HCV (HRQL), multidimensional fatigue inventory, and WPAI. Baseline scores were obtained in 59% of the studies, while 45% of the studies measured scores during treatment (range:1-48 weeks). Post-treatment follow-up scores were obtained in 42% (24 weeks post treatment). Baseline, HRQL impairment was noted in CH-C patients (mean differences from population norm PCS score: -3 to -13 [p values 0.05-0.010] and MCS score: -4 to -10 [p≤0.05]), with further impairment during treatment to reach its lowest point after 4-8 weeks of treatment (PCS score: -5.5 to - 6.9 and MCS score:-3.9 to -6.8 for MCS [p <0.05]). At 24 weeks post treatment, SVR increased baseline scores for PCS 3.6 to 4.2 and 1.2 to 2.0 for MCS (p<0.05). Work productivity/absenteeism worsened during treatment and returned to baseline 12 weeks after treatment. Baseline predictors of HRQL were fatigue, depression, anxiety, disease stigma, and sleep difficulties. Furthermore, cirrhosis was associated with a marked decrease in scores. Treatment with regimens that contained RBV but not IFN produced minimal decline in HRQL during treatment while IFN-free, RBV-free regimens showed improvement of HRQL scores during treatment. Finally, achievement of sustained virologic response (SVR) was associated with an increase in HRQL scores. Conclusion: HCV has a negative impact on HRQL. IFN/RBV containing regimens worsen this impairment. IFN- and RBV-free regimens result in improving HRQL scores during treatment. SVR is consistently associated with improvement of HRQL scores post treatment.