EVALUATING THE QUALITY-OF-LIFE ASSOCIATED WITH RIFABUTIN PROPHYLAXIS FOR MYCOBACTERIUM-AVIUM COMPLEX IN PERSONS WITH AIDS - COMBINING Q-TWIST AND MULTIATTRIBUTE UTILITY TECHNIQUES

Our objective was to evaluate the effect of rifabutin prophylaxis in p atients with AIDS and CD4 counts of less than 200 per cubic millimetre using a combination of Q-TWiST (quality-adjusted time without symptom s and toxicity) and multiattribute health utility assessment, The desi gn consisted of a secondary analysis of two previously reported multic entre, 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 56 2 were assigned to a placebo. A modified Q-TWiST approach was used for comparing treatments based on the occurrence and duration of time wit h and without severe symptoms and clinical endpoints, Health states we re constructed to represent combinations of clinical events experience d by study patients. Five physicians assigned utilities for health sta tes using a six-attribute health classification system. These utilitie s were used to adjust survivial for QOL, The rifabutin and placebo gro ups were compared using estimated quality-of-life-adjusted days. The i ncidence of MAC was 9% for the rifabutin group and 18% for the placebo group (p < 0.001), Differences, although not statistically significan t, were observed for rates of survival and hospitalization. The rifabu tin group experienced less anaemia (p < 0.02), and fever and night swe ats (p < 0.02) than the placebo group. Average Q-TWIST days were 325 f or the rifabutin group and 309 for the placebo group (p < 0.05), Q-TWi ST days were significantly lower for patients with MAC bacteraemia (p < 0.04) and hospitalizations (p < (0.003). Rifabutin prophylaxis resul ted in fewer MAC infections and greater quality-of-life-adjusted days of survival compared to no rifabutin, Quality-of-life-adjusted surviva l, based on a combination of the Q-TWIST and multiattribute health uti lity index, is a feasible approach for evaluating the outcomes of medi cal treatment. Future studies should, however, use patient-assigned ut ility weights to compute Q-TWIST scores, since physician generated uti lities may differ significantly from those of patients.