Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway
Authors: Aas Christer Frode , Vold Jørn Henrik , Skurtveit Svetlana , Lim Aaron G. , Ruths Sabine , Islam Kamrul , Askildsen Jan Erik , Løberg Else-Marie , Fadnes Lars Thore , Johansson Kjell Arne ,   for the INTRO-HCV Study Group, Aas Christer Frode , Buljovcic Vibeke Bråthen , Chalabianloo Fatemeh , Daltveit Jan Tore , Alpers Silvia Eiken , Fadnes Lars T. , Eriksen Trude Fondenes , Gundersen Per , Hille Velinda , Håberg Kristin Holmelid , Johansson Kjell Arne , Leiva Rafael Alexander , Carlsen Siv-Elin Leirvåg , Bonnier Martine Lepsøy , Lorås Lennart , Løberg Else-Marie , Nordbotn Mette Hegland , Nygård Cathrine , Olsvold Maria , Ohldieck Christian , Sivertsen Lillian , Torjussen Hugo , Vold Jørn Henrik , Økland Jan-Magnus , Eielsen Tone Lise , Maldonado Nancy Laura Ortega , Wilk Ewa Joanna , Bjørnestad Ronny , Lygren Ole Jørgen , Pierron Marianne Cook , Dalgard Olav , Midgard Håvard , Skurtveit Svetlana , Vickerman Peter 
Published: September 2020

Abstract
Background
Opioid dependence carries the highest disease burden of all illicit drugs. Opioid agonist therapy (OAT) is an evidence-based medical intervention that reduces morbidity and mortality. There is limited knowledge on the health-related quality of life (HRQoL) of long-term patients in OAT. This study measures HRQoL and self-perceived health of long-term patients on OAT, compares the scores to a Norwegian reference population, and assesses changes in these scores at 1-year follow up.

Methods
We conducted a nested prospective cohort study among nine OAT outpatient clinics in Norway. 609 OAT patients were included, 245 (40%) followed-up one year later. Data on patient characteristics, HRQoL, and self-perceived health was collected. HRQoL was assessed with the EQ-5D-5L, which measures five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) on a five-point Likert scale (from “no problems” to “extreme problems”). An UK value set was applied to calculate index values (from 0 to 1) for the EQ-5D-5L and compare them to a Norwegian reference population. Self-perceived health was measured with EQ-VAS (from 0 to 100).

Results
Mean (standard deviation (SD)) EQ-5D-5L index value at baseline was 0.699 (0.250) and EQ-VAS 57 (22) compared to 0.848 (0.200) and 80(19) for the Norwegian reference population. There were large variations in EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The lowest EQ-5D-5L index values were observed for female patients, age groups older than 40 years and for methadone users. At follow-up, improvements in HRQoL were observed across almost all dimensions and found significant for mobility and pain/discomfort. Mean (SD) overall index value and EQ-VAS at follow up were 0.729 (0.237) and 59 (22) respectively.

Conclusion
The average HRQoL and self-perceived health of OAT patients is significantly lower than that of the general population, and lower than what has been found among other severe somatic and psychiatric conditions. Around 34% had very good HRQoL, higher than average Norwegian values, and around 5% had extremely poor HRQoL.