Health status versus utilities of patients with end-stage liver disease

Background: Health-related quality of life (HRQL) in patients with end-stage liver disease (ESLD) can be evaluated using either health-status questionnaires or utility assessment techniques. The two approaches have never been compared in terms of the values they assign to health prior to liver transplantation. Study design: We assessed health status of patients with ESLD using validated disease-specific instruments covering multiple domains (measures of disease, psychological status, personal function, social/role function, and general health perception). We also elicited utilities using formal approaches (standard gamble [SG] and time tradeoff [TTO]) and a simpler alternative (visual analog scale [VAS]). Patients: Outpatients and inpatients at a single center prior to liver transplantation (n = 78). Principal findings: Health status was generally poor (median physical symptoms score on a 0-1 [worst to best] scale, 0.33; psychological symptoms, 0; happiness, 0.50; personal function, 0; social/role function, 0.40; and general health perception, 0.40). The median VAS score was 0.50. The median TTO was 0.79, indicating that half of the patients in our sample chose healthier life in return for a 21% shorter life expectancy. The median SG score was 0.50, indicating that half of the patients were willing to take up to a 50% risk of death in exchange for perfect health. Conclusions: Both health status measures and utility assessments indicate that HRQL is compromised in patients awaiting liver transplantation. Despite the overall consistency between the two approaches, however, health status measures do not serve as reasonable proxies for utilities. For formal economic evaluations such as cost effectiveness analyses, only direct measures of utility can be used to quantify health states.