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. 2020 Sep 3;15(1):68.
doi: 10.1186/s13011-020-00309-y.

Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway

Christer Frode Aas  1   2 , Jørn Henrik Vold  3   4 , Svetlana Skurtveit  5   6 , Aaron G Lim  7 , Sabine Ruths  4   8 , Kamrul Islam  9   10 , Jan Erik Askildsen  10 , Else-Marie Løberg  3   11   12 , Lars Thore Fadnes  3   4 , Kjell Arne Johansson  3   4 ; INTRO-HCV Study Group
Collaborators, Affiliations

Health-related quality of life of long-term patients receiving opioid agonist therapy: a nested prospective cohort study in Norway

Christer Frode Aas et al. Subst Abuse Treat Prev Policy. .

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.

Keywords: EQ-5D; Epidemiology; Health related quality of life; Opiate substitution therapy; Opioid agonist therapy; Opioid dependence; Quality of life.

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Conflict of interest statement

None of the authors have competing interests.

Figures

Fig. 1
Fig. 1
Proportion of individuals reporting problems by EQ-5D-5L domain; overall, by age, gender and OAT medication. OAT = opioid agonist therapy. Altogether 609 respondents, 8 patients missed values on one dimension. 11 patients, which did not receive either methadone or buprenorphine-based medications are left out of the illustration but not analysis. Proportions (%) and dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). 1A: Overall, 1B: Gender 1C: OAT medication 1D: Age groups
Fig. 2
Fig. 2
Pen’s Parade: distribution from lowest to greatest health. Pen’s Parade: The distribution in baseline EQ-5D-5L index values, where 43% had > 0.8 and 5% had < 0.2 at baseline. The dotted line represent the average reported index value of the Norwegian reference population
Fig. 3
Fig. 3
EQ-5D-5L domains at baseline versus follow-up. OAT = opioid agonist therapy. Proportions (%) and dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Baseline and follow-up for the 245 patients who were eligible for follow-up analysis
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