Disparities in health utilities among hepatitis C patients receiving care in different settings

Yasmin A Saeed; Kate Mason; Nicholas Mitsakakis; Jordan J Feld; Karen E Bremner; Arcturus Phoon; Alice Fried; Josephine F Wong; Jeff Powis; Murray D Krahn; William Wl Wong

doi:10.3138/canlivj-2022-0009

Disparities in health utilities among hepatitis C patients receiving care in different settings

Can Liver J. 2023 Feb 28;6(1):24-38. doi: 10.3138/canlivj-2022-0009. eCollection 2023 Feb.

Authors

Yasmin A Saeed^{1

2}, Kate Mason³, Nicholas Mitsakakis⁴, Jordan J Feld⁵, Karen E Bremner², Arcturus Phoon², Alice Fried², Josephine F Wong², Jeff Powis^{3

6}, Murray D Krahn^{1

2

7}, William Wl Wong^{1

2

8}

Affiliations

¹ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
² Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.
³ Toronto Community Hep C Program (TCHCP), Toronto, Ontario, Canada.
⁴ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
⁵ Toronto Centre for Liver Disease, University Health Network, Toronto, Ontario, Canada.
⁶ Michael Garron Hospital, Toronto, Ontario, Canada.
⁷ Deceased 01 07 22.
⁸ School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.

Abstract

BACKGROUND: Although chronic hepatitis C (CHC) disproportionately affects marginalized individuals, most health utility studies are conducted in hospital settings which are difficult for marginalized patients to access. We compared health utilities in CHC patients receiving care at hospital-based clinics and socio-economically marginalized CHC patients receiving care through a community-based program. METHODS: We recruited CHC patients from hospital-based clinics at the University Health Network and community-based sites of the Toronto Community Hep C Program, which provides treatment, support, and education to patients who have difficulty accessing mainstream health care. We elicited utilities using six standardized instruments (EuroQol-5D-3L [EQ-5D], Health Utilities Index Mark 2/Mark 3 [HUI2/HUI3], Short Form-6D [SF-6D], time trade-off [TTO], and Visual Analogue Scale [VAS]). Multivariable regression analysis was performed to examine factors associated with differences in health utility. RESULTS: Compared with patients recruited from the hospital setting (n = 190), patients recruited from the community setting (n = 101) had higher unemployment (87% versus 67%), history of injection drug use (88% versus 42%), and history of mental health issue(s) (79% versus 46%). Unadjusted health utilities were lower in community than hospital patients (e.g., EQ-5D: 0.722 [SD 0.209] versus 0.806 [SD 0.195]). Unemployment and a history of mental health issue(s) were significant predictors of low health utility. CONCLUSIONS: Socio-economically marginalized CHC patients have lower health utilities than patients typically represented in the CHC utility literature. Their utilities should be incorporated into future cost-utility analyses to better represent the population living with CHC in health policy decisions.

Keywords: health utilities; patient preferences; patient-reported outcomes; quality of life; viral hepatitis.

Grants and funding

This study was supported by the Canadian Institutes of Health Research (CIHR) (Operating Grant #137490 and #PJT-148970). YA Saeed was supported by a Trainee Fellowship from the Canadian Network on Hepatitis C (CanHepC). CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (#NHC-142832) and the Public Health Agency of Canada (PHAC). These organizations were not involved in the design, conduct, or writing of this study.