Utility values for specific hepatic encephalopathy health states elicited from the general public in the United Kingdom.

Julian F Guest,Kam Nanuwa,Rob Barden

doi:10.1186/1477-7525-12-89

Abstract

Background and aimsTo elicit utility values for five health states corresponding to increasing severity of hepatic encephalopathy, from members of the general public in the UK. The health states studied were Conn grades 0, 1, 2, 3 and 4.MethodsInterviewer-administered time trade-off (TTO) and standard gamble (SG) utilities were elicited for the five health states from a random sample of 200 members of the general public in the UK, using health state descriptions validated by clinicians and members of the general public.ResultsRespondents’ mean age was 49.5 years and 49% were female. Mean utilities were 0.962 (TTO) and 0.915 (SG) for Conn grade 0; 0.912 (TTO) and 0.837 (SG) for Conn grade 1; 0.828 (TTO) and 0.683 (SG) for Conn grade 2; 0.691 (TTO) and 0.489 (SG) for Conn grade 3; and 0.429 (TTO) and 0.215 (SG) for Conn grade 4. The TTO and SG values between the five Conn grades were significantly different (p < 0.001). Additionally, the TTO value was significantly higher than the SG value for the corresponding state (p <0.0001).ConclusionThese findings quantify how different Conn grades and level of response to treatment may impact on the health-related quality of life of patients with hepatic encephalopathy. There were greater preference values for lower levels of disease, with the highest value associated with Conn grade 0. These health state preference values can be used to estimate the outcomes of different interventions for hepatic encephalopathy in terms of quality-adjusted life years.

Highlights

Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder caused by an accumulation of toxins in the bloodstream that are normally removed by the liver
The study sample comprised 200 participants who were interviewed in Greater London
The participants rated their current health with a utility value of 0.93 using a horizontal visual analogue scale (VAS)

Summary

Introduction

Hepatic encephalopathy (HE) is a reversible neuropsychiatric disorder caused by an accumulation of toxins in the bloodstream that are normally removed by the liver. HE encompasses a spectrum of neuropsychiatric abnormalities seen in patients with established liver disease, and is most commonly associated with liver cirrhosis [1,2]. HE can be graded using the Conn grade ( called the West Haven classification) in which higher scores indicate higher disease severity. Grade 0 represents no personality or behavioural abnormality detected. The system classifies patients as being “unimpaired” (no clinical neurophysiological/ neuropsychometric changes), or having “covert” HE (i.e. minimal HE or HE with a Conn grade of 1), or having “overt” HE (i.e. clinically relevant HE or HE with a Conn grade of 2, 3 or 4). To elicit utility values for five health states corresponding to increasing severity of hepatic encephalopathy, from members of the general public in the UK. The health states studied were Conn grades 0, 1, 2, 3 and 4

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Discussion

Conclusion