Complications in liver cirrhosis (LC) are associated with increased mortality and costs. Management of LC complications is well established in clinical practice, but their real effectiveness is difficult to measure. Assessment of outcome indicators (OIs) together with patients-health related quality of life (p-HRQoL) could help decision-making process for clinicians and administrators. Aim: The aim of our study was to identify a set of OIs, and apply them in the clinical assessment of compensated (CC) and decompensated cirrhosis (DC), together with p-HRQoL scales. Specific OIs chosen by a panel of hepatologists with a modified Delphi method, were tested in a prospective multicenter observational study. P-HRQoL collected using the EQ-5D questionnaire, generated an health profile with five utility domains (mobility, self care, anxiety/depression,usualactivitiesandpain),and a visual analogue scale, which measured overall p-HRQoL in a range from 0 to 100. We enrolled 1772 patients with LC in 18 months: 1015 CC and 757 DC; median follow-up time was 2 years. Results: Variceal bleeding had an annual incidence of 3.1% with 1-year survival of 76%. Hepatocellular carcinoma occurred in a rate of 3.5%peryear,and 83%CC patients were diagnosed at earlystage. The strongest OIs according to the experts were decompensation rate in CC, which was 6.6% per year, and overall survival in DC patients.The1 yearsurvival aftert he first decompensation episode (ascites in 73% of cases) was 96% for CPT-A, 82% CPT-B, 56% CPT-C, whereas it was 94% and 57% for MELD score respectively below or above 15. Interestingly,no significant changes in p-HRQoL between baseline and after 2 years were found in CC and CPT-A patients, while p-HRQoL progressively decreased in DC and CPT B-C. Conclusions: Systematic measurement and comparison of objective OIs and p-HRQoL scales could increase value-based care in liver cirrhosis patients.
Okolicsanyi, S., Ciaccio, A., Cortesi, P., Rota, M., Gemma, M., Giani, P., et al. (2014). Measurement of clinical outcomes and quality of life indicators as a new value-based approach to liver cirrhosis management. DIGESTIVE AND LIVER DISEASE, 46(Supplement 4), e129-e129 [10.1016/j.dld.2014.08.005].
Measurement of clinical outcomes and quality of life indicators as a new value-based approach to liver cirrhosis management
OKOLICSANYI, STEFANO;CIACCIO, ANTONIO;CORTESI, PAOLO ANGELO;ROTA, MATTEO;GEMMA, MARTA;SCALONE, LUCIANA;MANTOVANI, LORENZO GIOVANNI;Fagiuoli, S;VALSECCHI, MARIA GRAZIA;CESANA, GIANCARLO;STRAZZABOSCO, MARIO
2014
Abstract
Complications in liver cirrhosis (LC) are associated with increased mortality and costs. Management of LC complications is well established in clinical practice, but their real effectiveness is difficult to measure. Assessment of outcome indicators (OIs) together with patients-health related quality of life (p-HRQoL) could help decision-making process for clinicians and administrators. Aim: The aim of our study was to identify a set of OIs, and apply them in the clinical assessment of compensated (CC) and decompensated cirrhosis (DC), together with p-HRQoL scales. Specific OIs chosen by a panel of hepatologists with a modified Delphi method, were tested in a prospective multicenter observational study. P-HRQoL collected using the EQ-5D questionnaire, generated an health profile with five utility domains (mobility, self care, anxiety/depression,usualactivitiesandpain),and a visual analogue scale, which measured overall p-HRQoL in a range from 0 to 100. We enrolled 1772 patients with LC in 18 months: 1015 CC and 757 DC; median follow-up time was 2 years. Results: Variceal bleeding had an annual incidence of 3.1% with 1-year survival of 76%. Hepatocellular carcinoma occurred in a rate of 3.5%peryear,and 83%CC patients were diagnosed at earlystage. The strongest OIs according to the experts were decompensation rate in CC, which was 6.6% per year, and overall survival in DC patients.The1 yearsurvival aftert he first decompensation episode (ascites in 73% of cases) was 96% for CPT-A, 82% CPT-B, 56% CPT-C, whereas it was 94% and 57% for MELD score respectively below or above 15. Interestingly,no significant changes in p-HRQoL between baseline and after 2 years were found in CC and CPT-A patients, while p-HRQoL progressively decreased in DC and CPT B-C. Conclusions: Systematic measurement and comparison of objective OIs and p-HRQoL scales could increase value-based care in liver cirrhosis patients.
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