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Abstract
This thesis examines the effect of hepatitis C virus infection (HCV) on health-related quality of life (HRQOL) to
define burden of disease at individual and population levels. A systematic review of HCV HRQOL studies was
undertaken with translation of Short Form-36 (SF-36) Health Survey data into community-weighted health state utilities
using three different methods. Derived estimates of health utilities were 0.87 for HCV treatment-induced sustained
virological response (SVR); 0.81 for pre-cirrhosis; 0.76 for compensated cirrhosis; 0.69 for decompensated cirrhosis;
0.67 for hepatocellular carcinoma (HCC); and 0.77 for liver transplant. The HCV health state utilities varied
considerably from expert estimates, with relatively lower estimates for early liver disease and higher estimates for
advanced liver disease, but were comparable to direct patient-elicited utilities.
A study utilising data from population-based health surveys incorporating HCV screening among prisoners at
Australian correctional centres in 1996 and 2001 showed no measurable effect of HCV on HRQOL, including that
attributable to HCV viraemia. Compared to uninfected Australian norms, prisoners had lower HRQOL irrespective of
HCV status. Several non-HCV factors such as age, co-morbidity, severity of depressive symptoms, and medical care
utilization influenced HRQOL.
A prospective study of health outcomes among HCV monoinfected and HIV/HCV coinfected individuals
conducted at Sydney tertiary level hepatitis clinics between 2003 and 2005 found similar cognitive function, mood, and
HRQOL patterns in these two HCV groups in the context of pegylated interferon (PEG-IFN) alfa-2a and ribavirin therapy.
The HCV groups had similar levels of pre-treatment HRQOL impairment, further on-treatment deterioration, and posttreatment
improvements. SVR was associated with significant HRQOL improvements, but mental HRQOL improvement
was also seen in individuals not achieving an SVR.
The impact of HCV treatment uptake on HCV-related burden of disease at a population level in Australia was
examined using a mathematical model. The model estimated that in 2004, there were ~181,500 cases of chronic HCV
infection, 7,020 with HCV-related cirrhosis, and annual incidence of 238 cases of HCV-related liver failure and 70 cases
of HCV-related HCC. Compared to no treatment, current treatment levels (~1% of HCV-infected individuals per annum)
would reduce projected HCV-related cirrhosis and advanced liver disease numbers by ~30% at 2020 and a gain of
~122,200 Quality-Adjusted Life Years (QALYs). Even with a five-fold increase from current treatment levels, advanced
liver disease numbers will continue to increase through 2020 but will be reduced by ~55% and a gain of ~483,200
QALYs.