Abstract
IntroductionHealth utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease.MethodsWe collected health utility data from Thai patients who were on TB treatment or had been successfully treated for TB for the purpose of economic modeling. Structured questionnaire and EuroQol (EQ-5D) and EuroQol visual analog scale (EQ-VAS) instruments were used as data collection tools. We compared utility of patients with two co-morbidities calculated using multiplicative model (UCAL) with the direct measures and fitted Tobit regression models to examine factors predictive of health utility and to assess difference in health utilities of patients in various medical conditions.ResultsOf 222 patients analyzed, 138 (62%) were male; median age at enrollment was 40 years (interquartile range [IQR], 35–47). Median monthly household income was 6,000 Baht (187 US$; IQR, 4,000–15,000 Baht [125–469 US$]). Concordance correlation coefficient between utilities measured using EQ-5D and EQ-VAS (UEQ-5D and UVAS, respectively) was 0.6. UCAL for HIV-infected TB patients was statistically different from the measured UEQ-5D (p-value<0.01) and UVAS (p-value<0.01). In tobit regression analysis, factors independently predictive of UEQ-5D included age and monthly household income. Patients aged ≥40 years old rated UEQ-5D significantly lower than younger persons. Higher UEQ-5D was significantly associated with higher monthly household income in a dose response fashion. The median UEQ-5D was highest among patients who had been successfully treated for TB and lowest among multi-drug resistant TB (MDR-TB) patients who were on treatment.ConclusionsUCAL of patients with two co-morbidities overestimated the measured utilities, warranting further research of how best to estimate utilities of patients with such conditions. TB and MDR-TB treatments impacted on patients' self perceived health status. This effect diminished after successful treatment.
Highlights
Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease
After giving written informed consent, patients were enrolled and assigned into mutually exclusive groups according to their medical condition: 1) TB patients receiving TB treatment (TBTX), 2) multidrug resistant TB (MDR-TB) patients receiving MDR-TB treatment (MDRTX), 3) patients who had been successfully treated for TB or MDR-TB according to World Health Organization definition and finished treatment for $6 months, 4) HIV-infected patients at any stage who had not been diagnosed with TB, 5) HIVinfected TB patients receiving TB treatment (TBTX/HIV), and 6) HIV-infected patients who had been successfully treated for TB or MDR-TB and finished treatment for $6 months
MDR-TB patients were diagnosed with the disease for a median of 9 months (IQR, 4–11); effective treatment was initiated relatively quickly after diagnosis
Summary
Health utilities of tuberculosis (TB) patients may be diminished by side effects from medication, prolonged treatment duration, physical effects of the disease itself, and social stigma attached to the disease. [6,7,8] As such, patients’ health-related quality of life (HRQL), i.e., valued aspects of life, may be diminished by side effects from medication, prolonged treatment duration, and in some cultures, social stigma attached to the disease. [18] While health utilities, as input in costutility analyses, allow comparison between populations and across diseases, settings, and countries, information generated from specific instruments focus on problems associated with single disease states, patient groups, or areas of function and do not allow broad comparison. In 2008, Kittikraisak et al conducted a prospective observational study to evaluate the impact of TB and HIV treatment on HRQL among 849 TB patients in Thailand. With increasing interest in identifying cost-effective interventions that are responsive to patients’ needs, HRQL data collected using standardized instruments are urgently needed
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