Quality of Life in Patients with HBV Infection: A Systematic Review and Meta-Analysis

Background & Aims Despite nearly 250 million people worldwide estimated to have chronic hepatitis B virus (HBV) infection, health-related quality of life (HRQOL) in HBV-related disease has not been well characterised. We aimed to summarise existing data on HBV-related HRQOL and quantify summary utility values by stage of disease. Methods Embase, Global Health, PubMed, and Web of Science were searched for articles investigating HBV HRQOL. Meta-analyses for utility scores were pooled by stage of disease and utility instrument; meta-regression was further adjusted for the effect of current health expenditure as a percentage of gross domestic product (CHE/GDP) as a proxy of the importance of healthcare perceived by different countries. Results Twenty-two articles from nineteen studies, comprising 10,311 patients, were included. 74% of studies were performed in the Western Pacific Region, and 47% used the EuroQoL-5D-3L instrument. HRQOL was found to decrease with advancing stages of HBV-related disease. Meta-regression showed the following predicted mean utility scores for the different stages of chronic HBV infection: non-cirrhotic 0.842, compensated cirrhosis 0.820 (p=0.474 compared to non-cirrhotic), decompensated cirrhosis 0.722 (p=0.001) and hepatocellular carcinoma 0.749 (p=0.008). The type of tool used affected HRQOL and studies in populations where there was a higher CHE/GDP were associated with higher predicted utility values. Conclusions Chronic HBV infection impairs patients' HRQOL, even when there is no evidence of cirrhosis, and HRQOL is particularly impaired in the advanced stages of decompensated cirrhosis and hepatocellular carcinoma. These results have important implications for global hepatitis elimination efforts and are useful for economic analyses. However, further research is needed, particularly in high-burden, low-income settings where data is lacking. Impact and Implications This study's findings from 22 articles and 10,311 patients contribute to the previous lack of a comprehensive synthesis of the impact of chronic hepatitis B virus (HBV) infection on patients’ health-related quality of life (HRQOL) worldwide. The novel findings urge the need to consider HRQOL in disease management and elimination targets, the need for further data from low- to middle-income settings, and the effects of treatment on HRQOL. The results highlight the need for clinicians to consider the effect of chronic HBV infection on patients’ lives and thus guide management and for researchers to identify knowledge gaps and areas to strengthen the quality of articles and studies. The results are also important for cost-effectiveness analysis and global hepatitis elimination efforts.