Chronic liver diseases (CLDs) are a major health problem that requires complex and costly treatments. Liver-specific clinical outcome indicators (COIs) able to assist both clinicians and administrators in improving the value of care are presently lacking. The Value-based Medicine in Hepatology (VBMH) study aims to fill this gap, devising and testing a set of COIs for CLD, that could be easily collected during clinical practice. Here we report the COIs generated and recorded for patient with HBV or HCV infection at different stages of the disease. METHODS/RESULTS: In the first phase of VBMH study, COIs were identified, based on current international guidelines and literature, using a modified Delphi method and a RAND 9-point appropriateness scale. In the second phase, COIs were tested in an observational, longitudinal, prospective, multicenter study based in Lombardy, Italy. Eighteen COIs were identified for HBV and HCV patients. Patients with CLD due to HBV (547) or HCV (1391) were enrolled over an 18-month period and followed for a median of 4 years. The estimation of the proposed COIs was feasible in the real word clinical practice and COIs values compared well with literature data. Further, the COIs were able to capture the impact of new effective treatments like DAAs in the clinical practice. CONCLUSIONS: The COIs efficiently measured clinical outcomes at different stages of CLDs. While specific clinical practice settings and related health-care systems may modify their implementation, these indicators will represent an important component of the tools for a value-based approach in Hepatology and will positively affect care delivery.
Clinical outcome indicators in chronic hepatitis B and C: A primer for value based medicine in hepatology
Fabris, Luca;
2019
Abstract
Chronic liver diseases (CLDs) are a major health problem that requires complex and costly treatments. Liver-specific clinical outcome indicators (COIs) able to assist both clinicians and administrators in improving the value of care are presently lacking. The Value-based Medicine in Hepatology (VBMH) study aims to fill this gap, devising and testing a set of COIs for CLD, that could be easily collected during clinical practice. Here we report the COIs generated and recorded for patient with HBV or HCV infection at different stages of the disease. METHODS/RESULTS: In the first phase of VBMH study, COIs were identified, based on current international guidelines and literature, using a modified Delphi method and a RAND 9-point appropriateness scale. In the second phase, COIs were tested in an observational, longitudinal, prospective, multicenter study based in Lombardy, Italy. Eighteen COIs were identified for HBV and HCV patients. Patients with CLD due to HBV (547) or HCV (1391) were enrolled over an 18-month period and followed for a median of 4 years. The estimation of the proposed COIs was feasible in the real word clinical practice and COIs values compared well with literature data. Further, the COIs were able to capture the impact of new effective treatments like DAAs in the clinical practice. CONCLUSIONS: The COIs efficiently measured clinical outcomes at different stages of CLDs. While specific clinical practice settings and related health-care systems may modify their implementation, these indicators will represent an important component of the tools for a value-based approach in Hepatology and will positively affect care delivery.Pubblicazioni consigliate
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