# Presentation: 012309

## The impact of Genital Herpes on Health Status Preferences   Raj PatelUniversity of Southampton

## Agenda 

**Background**
**Methods**
**Study results**
**Conclusions**

## Background 

**Genital Herpes has substantial impact on morbidity and quality of life**
**Pain, anxiety, depression and social isolation **
**Impact on infected individuals and their partners**
**Utilities quantify patients’ preferences **
**Utilities combine measurement of the physical and psychosocial effects of a disease into one number that represents the overall impact**
**Suppressive antiviral therapy reduces:**
**frequency of genital herpes recurrences**
**sexual transmission of genital herpes (valaciclovir)**

## Study Objective 

**Measure utilities associated with genital herpes health states **
**Quantify their impact on the quality-adjusted life of an infected person and their partner**
*** ***

## Methods

**Develop genital herpes health states**
**Random sample of US general population, recruited through a Web-TV based survey network**
**Measuring utilities:**
**Feeling Thermometer used to familiarize respondents with the health states and the notion of preferences**
**Standard Gamble technique accounts for risk**
**Utility weights from 0.0, reflecting death, to 1.0, reflecting perfect health **

## Identification of health states

**Patient health states**
**Asymptomatic state between infrequent episodes**
**Asymptomatic state between frequently recurring episodes**
**Asymptomatic state while taking suppressive therapy**
**Primary/recurrent, non-classic (mild) episode**
**Recurrent, classic episode**
**Primary, classic episode**
**Partner health states**
**Healthy with partner who has genital herpes**
**Healthy with partner who has genital herpes and who is taking suppressive therapy**

## Description of health states

**Attributes used in health state description:**
**Appearance**
**Symptomatology**
**Transmission of disease**
**Psychosocial/functioning impact**
**Medical therapy**

## Feeling Thermometer 

**Familiarise respondents with the health state and the notion of preference**
**Participants asked to rank health states on a scale in which 100 is perfect health and 0 reflects death**

**Perfect Health**

**Death**

- 100

- 90

- 80

- 70

- 60

- 50

- 40

- 30

- 20

- 10

## Standard Gamble 

**Health**
**State**
**“****X”**

- P

- 1-P

- Death

- Perfect Health

**P**** is varied until the person is indifferent  ****(P****i****) ****between the certain option of Health State “X” and the gamble. **
**P****i**** = Utility**

- Drummond, FM. *et al.*(1997). *Methods for the Economic Evaluation of health Care Programmes*. Oxford University Press. Oxford.

- Chance of perfect health

- Chance of death

## Standard Gamble question example

**Imagine that you are in Health State “GREEN”.  You can choose to stay in Health State “GREEN”, or you can choose to take a chance.  If the chance offered is a 90% chance of Perfect Health and a 10% chance of Death, would you take the chance or stay in Health State “GREEN”? **

**CHOICE A**

- Health State “GREEN” 100%

- Death 10%

- Perfect Health 90%

**CHOICE B**

**Choice A**

**Choice B**

**No preference**

***Utility = 0.90***

## Study Population 

**	****	****	****	****	****	***Population**	**	**	**	**	**	**	**	**  (N = 938)*
**Gender**
**	*****Female ******	*****	****	****	****484 ( 52%)**
**Age**
**	*****18 to <30***** ****	****	****	****	****157 ( 17%)**
**	*****30 -  44 years***** ****	****	****	****275 ( 29%)**
**	*****45 - 59 years***** ****	****	****	****	****279 ( 30%)**
**	*****60 + years***** ****	****	****	****	****227 ( 24%)**
**Marital status**
**	*****Married *****	****	****	****	****565 ( 60%)**
**	*****Single***** ****	****	****	****	****202 ( 22%)**
**	*****Other *****	****	****	****	****171 ( 18%)**
**Highest education**
**	*****Less than high school***** ****	****	****84  (  9%) **
**	*****High school ******	*****	****	****	****302 ( 32%)**
**	*****College/graduate school***** ****	****	****552 ( 59%)**
** **
** **

**Sample is representative of the general US population **

## Utility scores for adult health states  - Feeling Thermometer 

**Perfect Health**

**Death**

**Asymptomatic with suppressive therapy (0.63)**

**Asymptomatic between infrequent episodes (0.61)**

**Asymptomatic between frequent episodes (0.52)**

**Primary/recurrent non-classic episode (0.49)**

**Recurrent classic episode (0.38)**

**Primary classic episode (0.28)**

**100**

**0**

## Utility scores for adult partner health states - Feeling Thermometer 

**Perfect Health**

**Death**

**Healthy with infected partner (0.64)**

**100**

**0**

**Healthy with infected partner taking suppressive therapy (0.68)**

**100**

**0**

- Healthy with infected partner taking suppressive therapy
- Healthy with infected partner

**Partner has STD **
***(n =12)***

**0.62**

**0.60**

## Standard Gamble utilities scores for adult health states

**Asymptomatic- suppressive therapy ****	****          ****0.78**** **

**Asymptomatic- between infrequent episodes   ****0.77**** **

**Asymptomatic- between frequent episodes       ****0.72**** **

**Primary/recurrent non-classic episode              ****0.70**** **

**Recurrent classic episode                                   ****0.60**** **

**Primary classic episode                                       ****0.46**** **

*Health State*

**     ****SG score****   x  12 months = ****Quality adjusted**
**	****	****	****	****life months (QALM)**

**Jan**

**Jul**

**Dec**

## Standard Gamble utilities scores for adult partner health states 

**Healthy with infected partner**
**taking suppressive therapy****	****       ****0.79****       **

*Health State*

**     ****SG score****   x  12 months = ****Quality adjusted**
**	****	****	****	****life months (QALM)**

**Jan**

**Jul**

**Dec**

**Healthy with infected partner****	****      ****0.76****       **

**Partner has STD** ***(n = 12)***

- Healthy with infected partner taking
- suppressive therapy 		   **0.83 / 10 QALM**

- Healthy with infected partner 	   **0.78 / 9.4QALM**

## Clinical significance of Standard Gamble utility differences from published literature

**	****	****	****	****      ****Mild state ****	****      Severe state          Difference**
**Mild/mod HCV infection vs. ****	****	****0.79 ****	****	****0.60 ****	****	****  0.19**
**decompensated cirrhosis**1**	****	**
**Minor AIDS defining illness vs.****	****	****0.65 ****	****	**** 0.42 ****	****	****  0.23**
**major AIDS defining illness**2** ****	****	**
**Mild vs.. severe tuberculosis ****	****	****0.79 ****	****	****0.50    ****	****	****  0.29**
**infection**3**	****	****	****	**

**1** Chong, CA. *et al. Am J Gastroenterol* 2003;98:630-8
- 2 Bayoumi, AM. *et al. Quality of Life Res* 1999; 8:471-80
- 3  Dion, MJ. *et al.* *Med Decis Making* 2002;22 (Suppl):S102-S114

## Study conclusions 

**Genital herpes can have a substantial detrimental impact on individual’s overall health state**
**Individuals without the disease value not getting genital herpes - i.e. interventions that protect against acquisition and spread**
**Interventions that prolong asymptomatic health states and reduce transmission risk can improve a patient’s and their partner’s quality adjusted life **

## Acknowledgements 

- Gale Harding1
- Kathleen Beusterien1
- Jean-Elie Malkin2
- 1 Medtap International Inc, Bethesda, MD
- 2 Centre Medical Institut Pasteur, Paris, France