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Quality-of-Life Tradeoffs for Hepatitis C Treatment: Do Patients and Providers Agree?

Department of Public Health, Weill Medical College of Cornell University, brs2006{at}med.cornell.edu

Paul A. Teixeira, DrPH

Department of Public Health, Weill Medical College of Cornell University

Gil Weitzman, MD

Department of Medicine, Division of Gastroenterology and Hepatology and the Center for the Study of Hepatitis C Weill Medical College of Cornell University, New York

Alvin I. Mushlin, MD, ScM

Department of Public Health, Weill Medical College of Cornell University

Ira M. Jacobson, MD

Department of Medicine, Division of Gastroenterology and Hepatology and the Center for the Study of Hepatitis C Weill Medical College of Cornell University, New York

Background . Chronic hepatitis C (HCV) treatment is initiated infrequently by patients in urban settings. These patients often decline HCV treatment due to concerns about treatment side effects and have communication problems with their physicians. Methods. The authors investigated differences between how patients and providers evaluate the quality-of-life tradeoffs associated with HCV treatment in computer-assisted interviews. They interviewed 92 treatment-naive HCV patients at gastroenterology, methadone maintenance, and HIV clinics at 3 hospitals in New York City and 23 physicians or nurses experienced in treating HCV at other hospitals in New York City. Subjects completed rating scale and standard gamble evaluations of current health and hypothetical descriptions of HCV symptoms and treatment side effects on a scale from 0 (death or worse than death) to 1 (best possible health). Results. Treatment side effects were rated worse by patients than providers using the rating scale (moderate side effects 0.42 v. 0.62; severe side effects 0.24 v. 0.40) and standard gamble (moderate side effects 0.61 v. 0.91; severe side effects 0.52 v. 0.75) (all P 0.01). A year of severe side effects was equivalent to 4.1 years of mild HCV symptoms avoided for patients if they returned to their current health after treatment compared with 2.0 years avoided if they achieved average population health. For patients with depression symptoms, HCV treatment with severe side effects had lower value unless it would also improve their current health. Conclusions. Patients have more concerns about treatment side effects than providers. Further research is warranted to develop HCV decision aids that elicit patient preferences and to evaluate how improved communication of the risks and benefits of HCV treatment and more effective treatment of depression may alter these preferences.

Key Words: patient preference • treatment acceptance • physician-patient relations • quality of life • hepatitis C.

This version was published on March 1, 2008

Medical Decision Making, Vol. 28, No. 2, 233-242 (2008)
DOI: 10.1177/0272989X07311753


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