Health-Related Quality of Life and Health Care Resource Utilization in Patients With Chronic Liver Disease and Primary Liver Cancer in the United States: Analysis of Medical Expenditure Panel Survey

Issah Younossi; Maria Stepanova; Mercedes Walters; Pegah Golabi; Manirath Srishord; Zobair M Younossi

doi:10.1016/j.jceh.2021.12.012

Health-Related Quality of Life and Health Care Resource Utilization in Patients With Chronic Liver Disease and Primary Liver Cancer in the United States: Analysis of Medical Expenditure Panel Survey

J Clin Exp Hepatol. 2022 Mar-Apr;12(2):272-277. doi: 10.1016/j.jceh.2021.12.012. Epub 2021 Dec 29.

Authors

Issah Younossi^{1

2}, Maria Stepanova^{1

2}, Mercedes Walters², Pegah Golabi^{1

3

4}, Manirath Srishord^{1

3}, Zobair M Younossi^{1

3

4}

Affiliations

¹ Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States.
² Center for Outcomes Research in Liver Diseases, Washington DC, United States.
³ Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, United States.
⁴ Inova Medicine, Inova Health System, Falls Church, VA, United States.

Abstract

Background: Worldwide, liver cancer (LC) is the fifth and third most common type of cancer and cancer-related mortality, respectively. Our aim was to assess health-related quality of life (HRQL) and resource utilization in chronic liver disease (CLD) patients with LC.

Methods: We used the Medical Expenditure Panel Survey 2004-2013. All patients had HRQL (Short Form-12, Patient Health Questionnaire-2, Kessler Psychological Distress Scale) and resource utilization data. We used patients with CLD without LC and colon cancer (CC) as controls.

Results: A total of 1882 CLD patients (53 ± 14 years, 45% male, 53% white, 15% black, 23% Hispanic, 6% Asian, 42% employed, 48% private insurance, and 11% uninsured) were included. Of the cohort, 102 (5.4%) patients had LC. LC patients were older, more likely to be male and white, less employed but less likely uninsured than CLD patients without LC (all P < 0.05). In comparison to both non-LC CLD and CC controls, LC had worse health: 40% vs. 27% vs. 25% reported fair health and 29% vs. 20% vs. 16% poor health status (P < 0.05). Furthermore, LC patients more frequently reported physical limitations: 51% vs. 35% vs. 35%, respectively (P = 0.01). Physical HRQL scores were lower in LC patients compared with both CLD and CC controls. Although mental health scores in LC were similar to non-LC CLD controls, they were lower than in CC. In addition, most aspects of healthcare resource utilization were higher for LC patients compared with both non-LC CLD and CC controls.

Conclusion: While having CLD causes impairment of patients' HRQL, LC further adds to this impairment and also contributes to a substantial resource utilization.

Keywords: CC, Colon cancer; CLD, Chronic liver disease; HCC, hepatocellular carcinoma; HRQL, Health-related quality-of-life; LC, Liver cancer; LD, Liver disease; LT, Liver transplantation; MEPS, Medical Expenditure Panel Survey; QoL, quality of life; SEER, Surveillance, Epidemiology, and End Results Program; disease burden; metabolic syndrome; national survey; outcomes; patient-reported outcomes.