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Published in: Health and Quality of Life Outcomes 1/2016

Open Access 01-12-2016 | Research

Quality of life utility values for hereditary haemochromatosis in Australia

Authors: Barbara de Graaff, Amanda Neil, Kristy Sanderson, Kwang Chien Yee, Andrew J. Palmer

Published in: Health and Quality of Life Outcomes | Issue 1/2016

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Abstract

Background

Hereditary hemochromatosis (HH) is a common autosomal recessive disorder amongst persons of northern European heritage. If untreated, iron accumulates in parenchymal tissues causing morbidity and mortality. As diagnosis often follows irreversible organ damage, screening programs have been suggested to increase early diagnosis. A lack of economic evidence has been cited as a barrier to establishing such a program. Previous analyses used poorly estimated utility values. This study sought to measure utilities directly from people with HH in Australia.

Methods

Volunteers with HH were recruited to complete a web-based survey. Utility was assessed using the Assessment of Quality of Life 4D (AQOL-4D) instrument. Severity of HH was graded into four categories. Multivariable regression analysis was performed to identify parameters associated with HSUV.

Results

Between November 2013 and November 2014, 221 people completed the survey. Increasing severity of HH was negatively associated with utility. Mean (standard deviation) utilities were 0.76 (0.21), 0.81 (0.18), 0.60 (0.27), and 0.50 (0.27) for categories 1–4 HH respectively. Lower mean utility was found for symptomatic participants (categories 3 and 4) compared with asymptomatic participants (0.583 v. 0.796). Self-reported HH-related symptoms were negatively associated with HSUV (r = −0.685).

Conclusions

Symptomatic stages of HH and presence of multiple self-reported symptoms were associated with decreasing utility. Previous economic analyses have used higher utilities which likely resulted in underestimates of the cost effectiveness of HH interventions. The utilities reported in this paper are the most robust available, and will contribute to improving the validity of future economic models for HH.
Literature
3.
go back to reference Feder JN. The hereditary hemochromatosis gene (HFE): a MHC class I-like gene that functions in the regulation of iron homeostasis. Immunol Res. 1999;20(2):175–85.CrossRefPubMed Feder JN. The hereditary hemochromatosis gene (HFE): a MHC class I-like gene that functions in the regulation of iron homeostasis. Immunol Res. 1999;20(2):175–85.CrossRefPubMed
4.
go back to reference Altes A et al. Prevalence of the C282Y, H63D, and S65C mutations of the HFE gene in 1,146 newborns from a region of Northern Spain. Genet Test. 2004;8(4):407–10.CrossRefPubMed Altes A et al. Prevalence of the C282Y, H63D, and S65C mutations of the HFE gene in 1,146 newborns from a region of Northern Spain. Genet Test. 2004;8(4):407–10.CrossRefPubMed
5.
go back to reference Pedersen P, Melsen GV, Milman N. Frequencies of the haemochromatosis gene (HFE) variants C282Y, H63D and S65C in 6,020 ethnic Danish men. Ann Hematol. 2008;87(9):735–40.CrossRefPubMed Pedersen P, Melsen GV, Milman N. Frequencies of the haemochromatosis gene (HFE) variants C282Y, H63D and S65C in 6,020 ethnic Danish men. Ann Hematol. 2008;87(9):735–40.CrossRefPubMed
6.
go back to reference Gagne G et al. Hereditary hemochromatosis screening: effect of mutation penetrance and prevalence on cost-effectiveness of testing algorithms. Clin Genet. 2007;71(1):46–58.CrossRefPubMed Gagne G et al. Hereditary hemochromatosis screening: effect of mutation penetrance and prevalence on cost-effectiveness of testing algorithms. Clin Genet. 2007;71(1):46–58.CrossRefPubMed
7.
go back to reference Adams PC, Valberg LS. Screening blood donors for hereditary hemochromatosis: decision analysis model comparing genotyping to phenotyping. Am J Gastroenterol. 1999;94(6):1593–600.CrossRefPubMed Adams PC, Valberg LS. Screening blood donors for hereditary hemochromatosis: decision analysis model comparing genotyping to phenotyping. Am J Gastroenterol. 1999;94(6):1593–600.CrossRefPubMed
8.
go back to reference Distante S et al. The origin and spread of the HFE-C282Y haemochromatosis mutation. Hum Genet. 2004;115(4):269–79.CrossRefPubMed Distante S et al. The origin and spread of the HFE-C282Y haemochromatosis mutation. Hum Genet. 2004;115(4):269–79.CrossRefPubMed
9.
go back to reference Olynyk JK et al. A population-based study of the clinical expression of the hemochromatosis gene. N Engl J Med. 1999;341(10):718–24.CrossRefPubMed Olynyk JK et al. A population-based study of the clinical expression of the hemochromatosis gene. N Engl J Med. 1999;341(10):718–24.CrossRefPubMed
10.
go back to reference Allen KJ et al. Iron-overload-related disease in HFE hereditary hemochromatosis. N Engl J Med. 2008;358(3):221–30.CrossRefPubMed Allen KJ et al. Iron-overload-related disease in HFE hereditary hemochromatosis. N Engl J Med. 2008;358(3):221–30.CrossRefPubMed
11.
go back to reference Mclaren CE et al. Prevalence of Heterozygotes for Hemochromatosis in the White-Population of the United-States. Blood. 1995;86(5):2021–7.PubMed Mclaren CE et al. Prevalence of Heterozygotes for Hemochromatosis in the White-Population of the United-States. Blood. 1995;86(5):2021–7.PubMed
12.
go back to reference Adams PC et al. Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med. 2005;352(17):1769–78.CrossRefPubMed Adams PC et al. Hemochromatosis and iron-overload screening in a racially diverse population. N Engl J Med. 2005;352(17):1769–78.CrossRefPubMed
13.
go back to reference Merryweather-Clarke A et al. Geography of HFE C282Y and H63D mutations. Genet Test. 2000;4(3):183–98.CrossRefPubMed Merryweather-Clarke A et al. Geography of HFE C282Y and H63D mutations. Genet Test. 2000;4(3):183–98.CrossRefPubMed
14.
go back to reference Biotechnology Australia. In: A.G.A.B. Australia, editor. Genetics in Family Medicine: The Australian Handbook for General Practitioners: Hereditary haemochromatosis. Canberra: National Health and Medical Research Council; 2007. Biotechnology Australia. In: A.G.A.B. Australia, editor. Genetics in Family Medicine: The Australian Handbook for General Practitioners: Hereditary haemochromatosis. Canberra: National Health and Medical Research Council; 2007.
15.
go back to reference Barton J, Edwards CQ. Hemochromatosis: Genetics, patholphysiology, diagnosis and treatment. U.K: Cambridge University Press; 2000.CrossRef Barton J, Edwards CQ. Hemochromatosis: Genetics, patholphysiology, diagnosis and treatment. U.K: Cambridge University Press; 2000.CrossRef
16.
go back to reference Adams P, Brissot P, Powell LW. EASL International Consensus Conference on Haemochromatosis. J Hepatol. 2000;33(3):485–504.CrossRefPubMed Adams P, Brissot P, Powell LW. EASL International Consensus Conference on Haemochromatosis. J Hepatol. 2000;33(3):485–504.CrossRefPubMed
17.
go back to reference Whitlock EP et al. Screening for hereditary hemochromatosis: A systematic review for the US Preventive Services Task Force. Ann Intern Med. 2006;145(3):209–23.CrossRefPubMed Whitlock EP et al. Screening for hereditary hemochromatosis: A systematic review for the US Preventive Services Task Force. Ann Intern Med. 2006;145(3):209–23.CrossRefPubMed
18.
go back to reference Powell LW et al. Screening for hemochromatosis in asymptomatic subjects with or without a family history. Arch Intern Med. 2006;166(3):294–301.CrossRefPubMed Powell LW et al. Screening for hemochromatosis in asymptomatic subjects with or without a family history. Arch Intern Med. 2006;166(3):294–301.CrossRefPubMed
19.
go back to reference Asberg A et al. Screening for hemochromatosis: High prevalence and low morbidity in an unselected population of 65,238 persons. Scand J Gastroenterol. 2001;36(10):1108–15.CrossRefPubMed Asberg A et al. Screening for hemochromatosis: High prevalence and low morbidity in an unselected population of 65,238 persons. Scand J Gastroenterol. 2001;36(10):1108–15.CrossRefPubMed
21.
go back to reference Ajioka RS, Kushner JP. Clinical consequences of iron overload in hemochromatosis homozygotes. Blood. 2003;101(9):3351–3. discussion 3354–8.CrossRefPubMed Ajioka RS, Kushner JP. Clinical consequences of iron overload in hemochromatosis homozygotes. Blood. 2003;101(9):3351–3. discussion 3354–8.CrossRefPubMed
22.
go back to reference Adams PC et al. The relationship between iron overload, clinical symptoms, and age in 410 patients with genetic hemochromatosis. Hepatology. 1997;25(1):162–6.CrossRefPubMed Adams PC et al. The relationship between iron overload, clinical symptoms, and age in 410 patients with genetic hemochromatosis. Hepatology. 1997;25(1):162–6.CrossRefPubMed
23.
go back to reference Allen KJ, Warner B, Delatycki MB. Clinical haemochromatosis in HFE mutation carriers. Lancet. 2002;360(9330):412–3. author reply 413–4.CrossRefPubMed Allen KJ, Warner B, Delatycki MB. Clinical haemochromatosis in HFE mutation carriers. Lancet. 2002;360(9330):412–3. author reply 413–4.CrossRefPubMed
24.
go back to reference Mundy L, Merlin T. Population genetic screening for haemochromatosis: identifying asymptomatic “at risk” homozygous individuals. Horizon Scanning Prioritising Summary, vol. 1. Adelaide: Adelaide Health Technology Assessment (AHTA); 2003. Mundy L, Merlin T. Population genetic screening for haemochromatosis: identifying asymptomatic “at risk” homozygous individuals. Horizon Scanning Prioritising Summary, vol. 1. Adelaide: Adelaide Health Technology Assessment (AHTA); 2003.
25.
go back to reference Adams P, Brissot P, Powell L. EASL International Consensus Conference on Haemochromatosis - Part II. Expert document. J Hepatol. 2000;33(3):487–96.CrossRef Adams P, Brissot P, Powell L. EASL International Consensus Conference on Haemochromatosis - Part II. Expert document. J Hepatol. 2000;33(3):487–96.CrossRef
26.
go back to reference Allen KJ. Population genetic screening for hereditary haemochromatosis: are we a step closer? Med J Aust. 2008;189(6):300–1.PubMed Allen KJ. Population genetic screening for hereditary haemochromatosis: are we a step closer? Med J Aust. 2008;189(6):300–1.PubMed
27.
go back to reference Barton JC, Acton RT. Population screening for hemochromatosis: has the time finally come? Curr Gastroenterol Rep. 2000;2(1):18–26.CrossRefPubMed Barton JC, Acton RT. Population screening for hemochromatosis: has the time finally come? Curr Gastroenterol Rep. 2000;2(1):18–26.CrossRefPubMed
28.
go back to reference Gertig DM, Hopper JL, Allen KJ. Population genetic screening for hereditary haemochromatosis. Med J Aust. 2003;179(10):517–8.PubMed Gertig DM, Hopper JL, Allen KJ. Population genetic screening for hereditary haemochromatosis. Med J Aust. 2003;179(10):517–8.PubMed
29.
go back to reference Wilson JM, Jungner YG. Principles and practice of mass screening for disease. Bol Oficina Sanit Panam. 1968;65(4):281–393.PubMed Wilson JM, Jungner YG. Principles and practice of mass screening for disease. Bol Oficina Sanit Panam. 1968;65(4):281–393.PubMed
30.
go back to reference Nisselle AE et al. Implementation of HaemScreen, a workplace-based genetic screening program for hemochromatosis. Clin Genet. 2004;65(5):358–67.CrossRefPubMed Nisselle AE et al. Implementation of HaemScreen, a workplace-based genetic screening program for hemochromatosis. Clin Genet. 2004;65(5):358–67.CrossRefPubMed
31.
go back to reference Grosse SD et al. Population screening for genetic disorders in the 21st century: evidence, economics, and ethics. Public Health Genomics. 2010;13(2):106–15.CrossRefPubMed Grosse SD et al. Population screening for genetic disorders in the 21st century: evidence, economics, and ethics. Public Health Genomics. 2010;13(2):106–15.CrossRefPubMed
32.
go back to reference Rogowski WH. The Cost-Effectiveness of Screening for Hereditary Hemochromatosis in Germany: A Remodeling Study. Med Decis Making. 2009;29(2):224–38.CrossRefPubMed Rogowski WH. The Cost-Effectiveness of Screening for Hereditary Hemochromatosis in Germany: A Remodeling Study. Med Decis Making. 2009;29(2):224–38.CrossRefPubMed
33.
go back to reference de Graaff B, et al. A Systematic review and narrative synthesis of health economic studies conducted for hereditary haemochromatosis. Appl Health Econ Health Policy. 2015;13(5):469–83.CrossRefPubMed de Graaff B, et al. A Systematic review and narrative synthesis of health economic studies conducted for hereditary haemochromatosis. Appl Health Econ Health Policy. 2015;13(5):469–83.CrossRefPubMed
34.
go back to reference National Institute for Health and Care Excellence (NICE). Guide to the methods of technology appraisal. United Kingdom: NICE; 2013. National Institute for Health and Care Excellence (NICE). Guide to the methods of technology appraisal. United Kingdom: NICE; 2013.
35.
go back to reference Pharmaceutical Benefits Advisory Committee. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Australian Government Department of Health: 2013. Pharmaceutical Benefits Advisory Committee. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Australian Government Department of Health: 2013.
36.
go back to reference Richardson J, Hawthore G. Negative Utility Scores and Evaluating the AQoL All Worst Health State. Melbourne: Monash University; 2001. Richardson J, Hawthore G. Negative Utility Scores and Evaluating the AQoL All Worst Health State. Melbourne: Monash University; 2001.
37.
go back to reference Patrick DL, et al. Measuring preferences for health states worse than death. Med Decis Making. 1994;14(1):9–18.CrossRefPubMed Patrick DL, et al. Measuring preferences for health states worse than death. Med Decis Making. 1994;14(1):9–18.CrossRefPubMed
38.
go back to reference Hawthorne G, Richardson J, Osborne R. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res. 1999;8(3):209–24.CrossRefPubMed Hawthorne G, Richardson J, Osborne R. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res. 1999;8(3):209–24.CrossRefPubMed
39.
go back to reference Hawthorne G, Richardson J, Day NA. A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments. Ann Med. 2001;33(5):358–70.CrossRefPubMed Hawthorne G, Richardson J, Day NA. A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments. Ann Med. 2001;33(5):358–70.CrossRefPubMed
40.
go back to reference Hawthorne G, Korn S, Richardson J. Population norms for the AQoL derived from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Public Health. 2013;37(1):7–16.CrossRefPubMed Hawthorne G, Korn S, Richardson J. Population norms for the AQoL derived from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Public Health. 2013;37(1):7–16.CrossRefPubMed
42.
go back to reference Mundy L, Merlin T. In: AHTA, editor. Population genetic screening for haemochromatosis: identifying asymptomatic “at risk” homozygous individuals. Horizon Scanning Prioritising Summary, vol. 1. Adelaide: AGDHA; 2004. Mundy L, Merlin T. In: AHTA, editor. Population genetic screening for haemochromatosis: identifying asymptomatic “at risk” homozygous individuals. Horizon Scanning Prioritising Summary, vol. 1. Adelaide: AGDHA; 2004.
43.
go back to reference Britt H, Henderson J, Charles J. General practice activity in Australia 2011–12. In: General Practice Series. Sydney: Sydney University Press; 2012. Britt H, Henderson J, Charles J. General practice activity in Australia 2011–12. In: General Practice Series. Sydney: Sydney University Press; 2012.
44.
45.
go back to reference Cullen W, Kearney Y, Bury G. Prevalence of fatigue in general practice. Ir J Med Sci. 2002;171(1):10–2.CrossRefPubMed Cullen W, Kearney Y, Bury G. Prevalence of fatigue in general practice. Ir J Med Sci. 2002;171(1):10–2.CrossRefPubMed
46.
go back to reference Kenter EG et al. Tiredness in Dutch family practice. Data on patients complaining of and/or diagnosed with “tiredness”. Fam Pract. 2003;20(4):434–40.CrossRefPubMed Kenter EG et al. Tiredness in Dutch family practice. Data on patients complaining of and/or diagnosed with “tiredness”. Fam Pract. 2003;20(4):434–40.CrossRefPubMed
48.
go back to reference Asberg A et al. Benefit of population-based screening for phenotypic hemochromatosis in young men. Scand J Gastroenterol. 2002;37(10):1212–9.CrossRefPubMed Asberg A et al. Benefit of population-based screening for phenotypic hemochromatosis in young men. Scand J Gastroenterol. 2002;37(10):1212–9.CrossRefPubMed
49.
go back to reference Adams PC, Kertesz AE, Valberg LS. Screening for hemochromatosis in children of homozygotes: prevalence and cost-effectiveness. Hepatology (Baltimore, Md). 1995;22(6):1720–7. Adams PC, Kertesz AE, Valberg LS. Screening for hemochromatosis in children of homozygotes: prevalence and cost-effectiveness. Hepatology (Baltimore, Md). 1995;22(6):1720–7.
50.
go back to reference Adams PC, Gregor JC, Kertesz AE, Valberg LS. Screening blood donors for hereditary hemochromatosis: decision analysis model based on a 30-year database. Gastroenterol Clin North Am. 1995;109:177–88. Adams PC, Gregor JC, Kertesz AE, Valberg LS. Screening blood donors for hereditary hemochromatosis: decision analysis model based on a 30-year database. Gastroenterol Clin North Am. 1995;109:177–88.
51.
go back to reference Fryback DG et al. US norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Med Care. 2007;45(12):1162–70.PubMedCentralCrossRefPubMed Fryback DG et al. US norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Med Care. 2007;45(12):1162–70.PubMedCentralCrossRefPubMed
52.
go back to reference McLernon DJ, Dillon J, Donnan PT. Health-state utilities in liver disease: a systematic review. Med Decis Making. 2008;28(4):582–92.CrossRefPubMed McLernon DJ, Dillon J, Donnan PT. Health-state utilities in liver disease: a systematic review. Med Decis Making. 2008;28(4):582–92.CrossRefPubMed
53.
go back to reference Lung TW et al. A meta-analysis of health state valuations for people with diabetes: explaining the variation across methods and implications for economic evaluation. Qual Life Res. 2011;20(10):1669–78.CrossRefPubMed Lung TW et al. A meta-analysis of health state valuations for people with diabetes: explaining the variation across methods and implications for economic evaluation. Qual Life Res. 2011;20(10):1669–78.CrossRefPubMed
54.
go back to reference Holland R et al. Patients’ self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death. J Card Fail. 2010;16(2):150–6.PubMedCentralCrossRefPubMed Holland R et al. Patients’ self-assessed functional status in heart failure by New York Heart Association class: a prognostic predictor of hospitalizations, quality of life and death. J Card Fail. 2010;16(2):150–6.PubMedCentralCrossRefPubMed
55.
go back to reference Sahinbegovic E et al. Musculoskeletal disease burden of hereditary hemochromatosis. Arthritis Rheum. 2010;62(12):3792–8.CrossRefPubMed Sahinbegovic E et al. Musculoskeletal disease burden of hereditary hemochromatosis. Arthritis Rheum. 2010;62(12):3792–8.CrossRefPubMed
56.
go back to reference Barton JC et al. Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in whites and blacks in the Hemochromatosis and Iron Overload Screening Study. Genet Test. 2005;9(3):231–41.CrossRefPubMed Barton JC et al. Initial screening transferrin saturation values, serum ferritin concentrations, and HFE genotypes in whites and blacks in the Hemochromatosis and Iron Overload Screening Study. Genet Test. 2005;9(3):231–41.CrossRefPubMed
57.
go back to reference McDonnell SM et al. A survey of 2,851 patients with hemochromatosis: Symptoms and response to treatment. Am J Med. 1999;106(6):619–24.CrossRefPubMed McDonnell SM et al. A survey of 2,851 patients with hemochromatosis: Symptoms and response to treatment. Am J Med. 1999;106(6):619–24.CrossRefPubMed
58.
go back to reference Adams PC, Speechley M. The effect of arthritis on the quality of life in hereditary hemochromatosis. J Rheumatol. 1996;23(4):707–10.PubMed Adams PC, Speechley M. The effect of arthritis on the quality of life in hereditary hemochromatosis. J Rheumatol. 1996;23(4):707–10.PubMed
Metadata
Title
Quality of life utility values for hereditary haemochromatosis in Australia
Authors
Barbara de Graaff
Amanda Neil
Kristy Sanderson
Kwang Chien Yee
Andrew J. Palmer
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2016
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-016-0431-9

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