Abstract
BackgroundWest Nile virus (WNV) infections are predominantly asymptomatic, although almost 1% become neuroinvasive and debilitating. We describe the impact of neuroinvasive and non-neuroinvasive disease on patient health-related quality of life (HRQoL).MethodsShort Form 36 questionnaire data came from a Canadian WNV cohort (Loeb 2008) of 154 patients followed for up to three years. We generated health utilities using the SF-6D. We calculated mean utility scores throughout follow-up and examined predictors using a linear mixed-effects model. We summarized HRQoL post-acute infection as: (i) long-term utility (mean of scores one year onward); (ii) area under the curve (AUC) one year onward. We examined predictors using beta regression. We used multiple imputation for sensitivity analysis.ResultsMean utility scores improved from 0.59 (95% CI: 0.38, 0.93) at baseline to 0.77 (0.53, 1) at six months, before plateauing for the remaining two years. Mean long-term utility was 0.81 (0.78, 0.85) and mean AUC was 0.80 (0.76, 0.84). Patients with neuroinvasive disease had consistently worse scores than their non-neuroinvasive counterparts, with the gap nearly closed after six months. After adjusting for confounding, neuroinvasive disease was not a significant predictor of HRQoL either throughout follow-up or post-acute infection. Rather, number of comorbidities and baseline utility scores were. Sensitivity analysis showed similar findings.ConclusionsPatients with WNV infection reported low HRQoL during acute illness, but improved rapidly by six months, regardless of neuroinvasive disease status. This is the first study reporting health utilities for WNV infection.
Highlights
West Nile virus (WNV) infections are predominantly asymptomatic, almost 1% become neuroinvasive and debilitating
In WNV infection, few studies have examined physical and mental impairments and none have accounted for patient preferences [3, 4]
We describe health-related quality of life (HRQoL) as utility scores in patients with WNV infection from a cohort study, comparing those with neuroinvasive and non-neuroinvasive diseases
Summary
West Nile virus (WNV) infections are predominantly asymptomatic, almost 1% become neuroinvasive and debilitating. We describe the impact of neuroinvasive and non-neuroinvasive disease on patient health-related quality of life (HRQoL). Measures of health-related quality of life (HRQoL) capture the social, emotional and physical domains of the patient. HRQoL can be expressed as utility scores, which capture patient preferences for different health states and are central to calculating cost-utility in economic evaluations [2]. In WNV infection, few studies have examined physical and mental impairments and none have accounted for patient preferences [3, 4]. We describe HRQoL as utility scores in patients with WNV infection from a cohort study, comparing those with neuroinvasive and non-neuroinvasive diseases. We examined sociodemographic and clinical characteristics associated with HRQoL
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