       Document 0662
 DOCN  M9610662
 TI    Evaluating the quality of life associated with rifabutin prophylaxis for
       Mycobacterium avium complex in persons with AIDS: combining Q-TWiST and
       multiattribute utility techniques.
 DT    9601
 AU    Revicki DA; Simpson KN; Wu AW; LaVallee RL; Medical Technology
       Assessment and Policy Research Program,; Battelle Centers for Public
       Health Research and Evaluation,; Arlington, VA 22201, USA.
 SO    Qual Life Res. 1995 Aug;4(4):309-18. Unique Identifier : AIDSLINE
       MED/96045252
 AB    Our objective was to evaluate the effect of rifabutin prophylaxis in
       patients with AIDS and CD4 counts of less than 200 per cubic millimetre
       using a combination of Q-TWiST (quality-adjusted time without symptoms
       and toxicity) and multiattribute health utility assessment. The design
       consisted of a secondary analysis of two previously reported
       multicentre, randomized, placebo-controlled clinical trials conducted in
       78 academic, community and Department of Veterans Affairs HIV centres
       and private practices. 542 patients with AIDS and CD4 counts of less
       than 200 per cubic millimetre were assigned to rifabutin 300 mg/day and
       562 were assigned to a placebo. A modified Q-TWiST approach was used for
       comparing treatments based on the occurrence and duration of time with
       and without severe symptoms and clinical endpoints. Health states were
       constructed to represent combinations of clinical events experienced by
       study patients. Five physicians assigned utilities for health states
       using a six-attribute health classification system. These utilities were
       used to adjust survival for QOL. The rifabutin and placebo groups were
       compared using estimated quality-of-life-adjusted days. The incidence of
       MAC was 9% for the rifabutin group and 18% for the placebo group (p <
       0.001). Differences, although not statistically significant, were
       observed for rates of survival and hospitalization. The rifabutin group
       experienced less anaemia (p < 0.02), and fever and night sweats (p <
       0.02) than the placebo group. Average Q-TWiST days were 325 for the
       rifabutin group and 309 for the placebo group (p < 0.05). Q-TWiST days
       were significantly lower for patients with MAC bacteraemia (p < 0.04)
       and hospitalizations (p < (0.003). Rifabutin prophylaxis resulted in
       fewer MAC infections and greater quality-of-life-adjusted days of
       survival compared to no rifabutin. Quality-of-life-adjusted survival,
       based on a combination of the Q-TWiST and multiattribute health utility
       index, is a feasible approach for evaluating the outcomes of medical
       treatment. Future studies should, however, use patient-assigned utility
       weights to compute Q-TWiST scores, since physician generated utilities
       may differ significantly from those of patients.
 DE    Analysis of Variance  Antibiotic Prophylaxis  Antibiotics,
       Antitubercular/*THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections/MORTALITY/*PREVENTION &  CONTROL  Clinical Trials/STATISTICS
       & NUMER DATA  Human  Mycobacterium avium-intracellulare
       Infection/MORTALITY/  *PREVENTION & CONTROL  *Quality-Adjusted Life
       Years  Rifabutin/*THERAPEUTIC USE  *Severity of Illness Index  Support,
       Non-U.S. Gov't  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

