Abstract
BackgroundIn patients with Crohn’s disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD.ObjectiveTo generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public.MethodsA cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method.ResultsResponses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05).ConclusionsTTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas.
Highlights
Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, often characterised by potentially debilitating symptoms such as abdominal pain, rectal bleeding, diarrhoea, fatigue and urgency [1]
206 patients with CD and 221 adults from the general population participated in the study
We found that the 10-year time trade-off (TTO) method discriminated well between health-related quality of life (HRQoL) of patients with active and inactive or no perianal fistulas
Summary
Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract, often characterised by potentially debilitating symptoms such as abdominal pain, rectal bleeding, diarrhoea, fatigue and urgency [1]. In patients with Crohn’s disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Objective To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. Results Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05). Conclusions TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas
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