of items 10 31 5 # of scales 6 8 5 Total score Yes Yes Yes Scales Physical functioning Vision Mobility

Author Brazier et al Feeney et al EuroQol Group

Pain Ambulation Pain/discomfort

Table 2. The Comparison of Content Domains among Different HRQOL Measures

Several studies have assessed health preference in chronic liver diseases, but the majority of them were on chronic hepatitis C (CHC) (Chong et al., 2003; McLernon, Dillon, & Donnan, 2008; Thein, Krahn, Kaldor, & Dore, 2005). Only two large studies evaluating health preference of CHB values were found in the literature (Levy et al., 2008; S C Ong et al., 2008). The first one was a multi-center study to elicit utilities for six hypothetical states from infected and uninfected individuals by Levy et al (Levy et al., 2008). The results found that health preference values declined with disease progressing from 0.68 in uncomplicated CHB to 0.35 in decompensated cirrhosis (DC) (Levy et al., 2008). Patients with DC and

Role limitations Hearing Self-care Social functioning Speech Usual activity

Mental Health Dexterity Anxiety/depression

Sullivan et al., 2007; Veenstra et al., 2008; Yuan et al., 2008).

Kong (C. L. K. Lam, Brazier, & McGhee, 2008).

Country UK USA

 Vitality Emotion Cognition Pain

Hepatitis B is a significant health problem in Southern China and Hong Kong. Chronic hepatitis B (CHB) is a chronic disease that puts significant demand on health services. Regular monitoring is needed for progression of disease and development of complications. Anti-viral treatments may be needed for the eradication of the virus and other interventions are required when complications develop. Understanding the impact of illness on quality of life can make health care more responsive to patients' needs. Studies have shown significant lower health-related quality of life (HRQOL) scores in CHB patients especially in the presence of complications. Data on HRQOL in patients with CHB are limited. Generic and disease specific measures can complement each other in the evaluation of the impact of CHB on HRQOL. The Chronic Liver Disease Questionnaire (CLDQ) is a liver disease-specific HRQOL measure applicable to patients with chronic liver disease at different stages of illness. It has the best face validity for adaptation to be used in Chinese patients with CHB in Hong Kong. There are lots of potential applications of HRQOL data of CHB patients. It can inform policy and practice to make health service more patient-centered. HRQOL may also be used as an outcome measure of effectiveness of treatment and quality of care. HRQOL can be converted into a preference value for the calculation of quality adjusted life year (QALYs) in cost-effectiveness analysis of medical intervention.

#### **4. References**


Reviews on the Epidemiology, Quality of Life, and Management of Chronic Hepatitis B (CHB) 395

Department of Health, H. K. S. A. R. Viral Hepatitis Preventive Service. 2010, from

Department of Health HKSAR. (1998). *Viral hepatitis & liver cancer and unintentional injuries in* 

Dias Teixeira, M. C., et al. (2005). A new insight into the differences among non-cirrhotic and

Dienstag, J. L., et al. (1999). Lamivudine as initial treatment for chronic hepatitis B in the

Dominick, K. L., & Ahern, F. M. (2004). Health-related quality of life and health service use among older adults with osteoarthritis. *Arthritis Rheum, 51*(3), 326-331. Eisen, G. M., et al. (1999). Health-related quality of life: a primer for gastroenterologists. *Am* 

Ethgen, O., & Kahler, K. (2002). The effect of health related quality of life on reported use of

European Association For the study of the liver. (2008). EASL Clinical practice guidelines: management of chronic hepatitis B. *Journal of hepatology, 50*, 227-242. Fattovich, G., et al. (2008). Natural history of chronic hepatitis B: special emphasis on disease

Feeny, D., et al. (1995). Multi-attribute health status classification systems. Health Utilities

Ferrer, M., et al. (2006). Validity of the Spanish version of the Chronic Liver Disease

Foster, G. R. (1999). Hepatitis C virus infection: quality of life and side effects of treatment. *J* 

Foster, G. R., et al. (1998). Chronic hepatitis C virus infection causes a significant reduction

Fung, J., et al. (2007). Adefovir dipivoxil monotherapy and combination therapy with

Fung, J., et al. (2008). New paradigms for the treatment of chronic hepatitis B. *J Gastroenterol* 

Gralnek, I. M., et al. (2000). Development and evaluation of the Liver Disease Quality of Life

Gust, I. D. (1996). Epidemiology of hepatitis B infection in the Western Pacific and South

Gutteling, J. J., et al. (2007). Overview of research on health-related quality of life in patients

Gutteling, J. J., et al. (2006). Determinants of quality of life in chronic liver patients. *Aliment* 

in quality of life in the absence of cirrhosis. *Hepatology, 27*, 209-212.

Questionnaire (CLDQ) as a standard outcome for quality of life assessment. *Liver* 

lamivudine for the treatment of chronic hepatitis B in an Asian population. *Antivir* 

instrument in persons with advanced, chronic liver disease--the LDQOL 1.0. *Am J* 

health care resources in patients with osteoarthritis and rheumatoid arthritis: a

cirrhotic patients using the liver disease quality of life instrument (LDQOL). *Ann* 

http://www.info.gov.hk/hepatitis/big5/index.htm

United States. *N Engl J Med, 341*(17), 1256-1263.

longitudinal analysis. *J Rheumatol, 29*(6), 1147-1155.

Index. *Pharmacoeconomics, 7*(6), 490-502.

progression and prognostic factors. *J Hepatol, 48*(2), 335-352.

*children*. Hong Kong (China).

*J Gastroenterol, 94*(8), 2017-2021.

*Hepatol, 4*(4), 264-271.

*Transpl, 12*(1), 95-104.

*Ther, 12*(1), 41-46.

*Hepatol*.

*Hepatol, 31*(Suppl 1), 250-254.

*Gastroenterol, 95*(12), 3552-3565. Guide to the methods of technology appraisal. from

East Asia. *Gut, 38 Suppl 2*, S18-23.

*Pharmacol Ther, 23*, 1629-1635.

http://www.nice.org.uk/niceMedia/pdf/TAP\_Methods.pdf

with chronic liver disease. *Neth J Med, 65*(7), 227-234.


Bayliss, M. S., et al. (1998). A questionnaire to assess the generic and disease-specific health outcomes of patients with chronic hepatitis C. *Qual Life Res, 7*(1), 39-55. Bernstein, D., et al. (2002). Relationship of health-related quality of life to treatment

Bianchi, G., et al. (2003). Reduced quality of life of patients with hepatocellular carcinoma.

Bondini, S., et al. (2007). Health-related quality of life in patients with chronic hepatitis B.

Brazier, J. E., et al. (2002). The estimation of a preference-based measure of health from the

Brown, R. S. (1999). Strategies and pitfalls in quality of life research. *Hepatology, 29 (Suppl 1)*,

Bruix, J., et al. (2005). Management of hepatocellular carcinoma. *Hepatology, 42*(5), 1208-1236. Casanovas, T., et al. (2003). Validation of the Spanish version of the Liver Disease Quality of Life questionnaire in transplant patients. *Transplant Proc, 35*(5), 1803-1805. Cella, D. F., & Tulsky, D. S. (1990). Measuring quality of life today: methodological aspects.

Chan, H. L., et al. (2007). Treatment of hepatitis B e antigen positive chronic hepatitis with telbivudine or adefovir: a randomized trial. *Ann Intern Med, 147*(11), 745-754. Chan, P. S., et al. (2007). Incremental benefit and cost-effectiveness of high-dose statin

Chang, S. C., et al. (2008). Factors associated with quality of life in chronic hepatitis C

Chang, T. T., et al. (2006). A comparison of entecavir and lamivudine for HBeAg-positive

Chen, C. J., et al. (2000). Epidemiology of hepatitis B virus infection in the Asia-Pacific

Chen, T., & Li, L. (2009). Influence of health-related quality of life on health service

Chong, C. A., et al. (2003). Health-state utilities and quality of life in hepatitis C patients. *Am* 

Cooksley, W. G., et al. (2003). Peginterferon alpha-2a (40 kDa): an advance in the treatment of hepatitis B e antigen-positive chronic hepatitis B. *J Viral Hepat, 10*(4), 298-305. Custer, B., et al. (2004). Global epidemiology of hepatitis B virus. *J Clin Gastroenterol, 38*(10

Dan, A. A., et al. (2008). Impact of chronic liver disease and cirrhosis on health utilities using

Dan, Y., et al. (2008). The economics of treating chronic hepatitis B in Asia. *Hepatology* 

primary care patients in China. *Int J Public Health, 54*(5), 325-332.

SF-6D and the health utility index. *Liver Transpl, 14*, 321-326.

therapy in high-risk patients with coronary artery disease. *Circulation, 115*(18),

patients who received interferon plus ribavirin therapy. *J Formos Med Assoc, 107*(6),

utilization in addition to socio-demographic and morbidity variables among

Brooks, R. (1996). EuroQol: the current state of play. *Health Policy, 37*(1), 53-72.

*Oncology (Williston Park), 4*(5), 29-38; discussion 69.

chronic hepatitis B. *N Engl J Med, 354*(10), 1001-1010.

region. *J Gastroenterol Hepatol, 15*(Suppl), E3-E6.

*J Gastroenterol, 98*(3), 630-638.

*International, 2*(3), 284-295.

Suppl), S158-168.

704-708.

9S-12S.

2398-2409.

454-462.

*Dig Liver Dis, 35*(1), 46-54.

SF-36. *J Health Econ, 21*, 271-292.

*Liver Int, 27*, 1119-1125.

adherence and sustained response in chronic hepatitis C patients. *Hepatology, 35*(3),


Reviews on the Epidemiology, Quality of Life, and Management of Chronic Hepatitis B (CHB) 397

Lai, C. L., et al. (2005). A 1-year trial of telbivudine, lamivudine, and the combination in

Lai, C. L., et al. (2002). Entecavir is superior to lamivudine in reducing hepatitis B virus

Lai, C. L., et al. (2006). Entecavir versus lamivudine for patients with HBeAg-negative

Lai, C. L., & Yuen, M. F. (2008). Chronic hepatitis B--new goals, new treatment. *N Engl J Med,* 

Lam, C. L., et al. (1999). Population based norming of the Chinese (HK) version of the SF-36

Lam, C. L. K., et al. (2008). Valuation of the SF-6D health states is feasible, acceptable, reliable, and valid in a Chinese population. *Value Health, 11*, 295-303. Lam, C. L. K., & Fong, D. Y. T. (2002). The effect of health-related quality of life (HRQOL) on health service utilisation of a Chinese population. *Soc Sci Med, 55*(9), 1635-1646. Lam, E. T., et al. (2008). Psychometrics and population norm of the Chinese (HK) SF-36

Lampertico, P., et al. (2005). Adefovir rapidly suppresses hepatitis B in HBeAg-negative

Lampertico, P., et al. (2007). Low resistance to adefovir combined with lamivudine: a 3-year

Lavanchy, D. (2004). Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. *J Viral Hepat, 11*(2), 97-107. Lavanchy, D. (2005). Worldwide epidemiology of HBV infection, disease burden, and

Lee, E. H., et al. (2007). Development and psychometric evaluation of a chronic liver diseasespecific quality of life questionnaire. *J Gastroenterol Hepatol, 23*, 231-238. Leung, N. (2008). Recent data on treatment of chronic hepatitis B with nucleos(t)ide

Levy, A. R., et al. (2008). The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. *Value Health, 11*, 527-538. Liaw, Y. F., et al. (2009). 2-Year GLOBE trial results: telbivudine Is superior to lamivudine in

Liaw, Y. F., et al. (2008). Asian-Pacific consensus statement on the management of chronic

Liaw, Y. F., et al. (2004). Lamivudine for patients with chronic hepatitis B and advanced liver

Lok, A. S., & McMahon, B. J. (2009). Chronic hepatitis B: update 2009. *Hepatology, 50*(3), 661-

Lok, A. S., et al. (1992). A controlled trial of interferon with or without prednisone priming

patients with chronic hepatitis B. *Gastroenterology, 136*(2), 486-495.

hepatitis B: a 2008 update. *Hepatology International, 2*(3), 263-283.

for chronic hepatitis B. *Gastroenterology, 102*(6), 2091-2097.

patients developing genotypic resistance to lamivudine. *Hepatology, 42*(6), 1414-

study of 145 lamivudine-resistant hepatitis B patients. *Gastroenterology, 133*(5), 1445-

*129*(2), 528-536.

*359*(23), 2488-2491.

1838.

1419.

1451.

662.

Lai, C. L., et al. (2003). Viral hepatitis B. *Lancet, 362*, 2089-2094.

Health Survey. *HK Pract, 21*, 460-470.

Health Survey version 2. *HK Pract, 30*, 185-198.

vaccine prevention. *J Clin Virol, 34 Suppl 1*, S1-3.

analogues. *Hepatol Int, 2*(2), 163-178.

disease. *N Engl J Med, 351*(15), 1521-1531.

chronic hepatitis B. *N Engl J Med, 354*(10), 1011-1020.

patients with hepatitis B e antigen-positive chronic hepatitis B. *Gastroenterology,* 

DNA in patients with chronic hepatitis B infection. *Gastroenterology, 123*(6), 1831-


Hadziyannis, S. J., et al. (2005). Long-term therapy with adefovir dipivoxil for HBeAg-

Hadziyannis, S. J., et al. (2006). Long-term therapy with adefovir dipivoxil for HBeAgnegative chronic hepatitis B for up to 5 years. *Gastroenterology, 131*(6), 1743-1751. Hadziyannis, S. J., et al. (2003). Adefovir dipivoxil for the treatment of hepatitis B e antigen-

Hauser, W., et al. (2004). Determinants of health-related quality of life in patients with

Hauser, W., et al. (2004). Validation of the German version of the Chronic Liver Disease

Hauser, W., et al. (2004). Biopsychosocial predictors of health-related quality of life in

Heitkemper, M., et al. (2001). Chronic hepatitis C. Implications for health-related quality of

Hong Kong (China). Dept. of Health. (1998). *Viral Hepatitis & Liver Cancer and Unintentional* 

Hong Kong Cancer Registry. (2006). *Fast Stats for Liver Cancer 2006*. Retrieved from

Hussain, K. B., et al. (2001). Comorbid illness is an important determinant of health-related

Jacobson, I. M. (2006). Therapeutic options for chronic hepatitis B: considerations and

Kang, S. C., et al. (2005). Health-related quality of life and impact of antiviral treatment in

Kanwal, F., et al. (2005). Treatment alternatives for chronic hepatitis B virus infection: a cost-

Kanwal, F., et al. (2008). Prospective validation of the short form liver disease quality of life

Keeffe, E. B., et al. (2008). A Treatment Algorithm for the Management of Chronic Hepatitis

Koff, R. S. (1999). Impaired health-related quality of life in chronic hepatitis C: the how, but

Kondo, Y., et al. (2007). Health-related quality of life of chronic liver disease patients with and without hepatocellular carcinoma. *J Gastroenterol Hepatol, 22*, 197-203. Kung, K., et al. (2004). Screening in chronic hepatitis B carriers - A retrospective study in a

Kwan, J. W., et al. (2008). The impact of chronic hepatitis C and co-morbid illnesses on

Lai, C. L., et al. (1998). A one-year trial of lamivudine for chronic hepatitis B. Asia Hepatitis

quality of life in patients with chronic hepatitis C. *Am J Gastroenterol, 96*, 2737-2744.

Chinese patients with chronic hepatitis C in Taiwan. *World J Gastroenterol, 11*, 7494-

B Virus Infection in the United States: 2008 Update. *Clinical Gastroenterology and* 

negative chronic hepatitis B. *N Engl J Med, 352*(26), 2673-2681.

negative chronic hepatitis B. *N Engl J Med, 348*(9), 800-807.

Questionnaire. *Eur J Gastroenterol Hepatol, 16*(6), 599-606.

life. *Gastroenterol Nurs, 24*(4), 169-175; quiz 176-167.

http://www3.ha.org.hk/cancereg/data/liver.pdf. Hong Kong Cancer Registry, H. A. (2008). Hong Kong Cancer Stat 2006.

controversies. *Am J Gastroenterol, 101 Suppl 1*, S13-18.

effectiveness analysis. *Ann Intern Med, 142*(10), 821-831.

instrument. *Aliment Pharmacol Ther, 28*(9), 1088-1101.

not the why. *Hepatology, 29*(1), 277-279.

primary care clinic. *H.K. Pract, 26*, 221-227.

health-related quality of life. *Qual Life Res, 17*(5), 715-724.

Lamivudine Study Group. *N Engl J Med, 339*(2), 61-68.

7498.

*Hepatology*.

*Injuries in Children*. Hong Kong: Dept. of Health.

chronic liver diseases. *Clin Gastroenterol Hepatol, 2*(2), 157-163.

patients with chronic hepatitis C. *Psychosom Med, 66*(6), 954-958.


Reviews on the Epidemiology, Quality of Life, and Management of Chronic Hepatitis B (CHB) 399

Nelson, E. C., & McHorney, C. A. (1998). A longitudinal study of hospitalization rates for

Neumann, P. J., et al. (2005). Growth and quality of the cost-utility literature, 1976-2001.

Nguyen, M. H., & Keeffe, E. B. (2009). Chronic hepatitis B: early viral suppression and longterm outcomes of therapy with oral nucleos(t)ides. *J Viral Hepat, 16*(3), 149-155. Nokhodian, Z., et al. (2009). Assessment of quality of life in hepatitis B patients in Iran.

Omata, M., et al. (2010). Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma. *Hepatol Int, 4*(2), 439-474. Ong, S. C., et al. (2009). Cultural adaptation and validation of a questionnaire for use in

Ong, S. C., et al. (2010). Reliability and validity of a Chinese version's health-related quality of life questionnaire for hepatitis B patients. *Value Health, 13*(2), 324-327. Ong, S. C., et al. (2008). Health-related quality of life in chronic hepatitis B patients.

Parkerson, G. R., Jr., & Gutman, R. A. (2000). Health-related quality of life predictors of survival and hospital utilization. *Health Care Financ Rev, 21*(3), 171-184. Perrillo, R., et al. (2004). Comparison of quality of life, work productivity and medical

Perz, J. F., et al. (2006). The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. *J Hepatol, 45*(4), 529-538. Peters, M. G., et al. (2004). Adefovir dipivoxil alone or in combination with lamivudine in

Poon, R. T., et al. (2001). A prospective longitudinal study of quality of life after resection of

Preedy, V. R., et al. (2010). Subjective Quality of Life Measures – General Principles and

Rapti, I., et al. (2007). Adding-on versus switching-to adefovir therapy in lamivudineresistant HBeAg-negative chronic hepatitis B. *Hepatology, 45*(2), 307-313. Ray, I., et al. (2010). Quality of life assessment of patients with chronic liver disease in

Rucci, P., et al. (2005). Validity and reliability of the Italian version of the Chronic Liver

Russell, L. B., et al. (1996). The role of cost-effectiveness analysis in health and medicine. Panel on Cost-Effectiveness in Health and Medicine. *Jama, 276*(14), 1172-1177.

resource utilization of peginterferon alpha 2a vs the combination of interferon alpha 2b plus ribavirin as initial treatment in patients with chronic hepatitis C. *J* 

patients with lamivudine-resistant chronic hepatitis B. *Gastroenterology, 126*(1), 91-

Concepts *Handbook of Disease Burdens and Quality of Life Measures* (pp. 381-399):

eastern India using a Bengali translation chronic liver disease questionnaire. *Indian* 

Disease Questionnaire (CLDQ-I) for the assessment of health-related quality of life.

*Serv Res, 32*(6), 759-774.

*Hepatology, 47*, 1108-1117.

*Viral Hepat, 11*(2), 157-165.

Springer New York.

*J Gastroenterol*.

*Dig Liver Dis, 37*(11), 850-860.

101.

*Indian J Gastroenterol, 28*(3), 116-117.

hepatitis B patients. *J Viral Hepat, 16*(4), 272-278.

hepatocellular carcinoma. *Arch Surg, 136*, 693-699.

*Value Health, 8*, 3-9.

patients with chronic disease: results from the Medical Outcomes Study. *Health* 


Maddrey, W. C. (2000). Hepatitis B: an important public health issue. *J Med Virol, 61*(3), 362-

Manolakopoulos, S., et al. (2008). Long-term therapy with adefovir dipivoxil in hepatitis B e

Marcellin, P., et al. (2003). Adefovir dipivoxil for the treatment of hepatitis B e antigen-

Marcellin, P., et al. (2008). Tenofovir disoproxil fumarate versus adefovir dipivoxil for

Marchesini, G., et al. (2001). Italian Study Group for Quality of Life in Cirrhosis: Factors

Martin, L. M., et al. (2006). Measurement of health-related quality of life in patients with

Martin, L. M., et al. (2002). The impact of liver disease on health-related quality of life: a

Martin, L. M., & Younossi, Z. M. (2005). Health-related quality of life (HRQL) in chronic

Martin, R. C., et al. (2007). Health-related quality of life: return to baseline after major and

Matsumura, S. (2000). Perceived health status as a predictor of utilization of health-care

Maynard, J. E. (1990). Hepatitis B: global importance and need for control. *Vaccine, 8 Suppl*,

McColl, E., et al. (1997). Making the right choice of outcome measure *Cross Cultural Health* 

McHutchison, J. G., et al. (2001). The effects of interferon alpha-2b in combination with

McLernon, D. J., et al. (2008). Health-state utilities in liver disease: a systematic review. *Med* 

McMahon, B. J. (2006). Selecting appropriate management strategies for chronic hepatitis B:

McMahon, B. J. (2008). Natural history of chronic hepatitis B - clinical implications. *Medscape* 

Merican, I., et al. (2000). Chronic hepatitis B virus infection in Asian countries. *J Gastroenterol* 

Miller, E. R., et al. (2001). Quality of life in HCV-infection: lack of association with ALT

Mucci, S., et al. (2010). [Cross-cultural adaptation of the Chronic Liver Disease

Questionnaire (CLDQ) to the Brazilian population]. *Cad Saude Publica, 26*(1), 199-

resources and the number of sick-leave days in Japan. *Quality of Life Research, 9*(9),

*Outcome Assessment: A User's Guide* (pp. 12-26): ERGHO, European Research Group

ribavirin on health related quality of life and work productivity. *J Hepatol, 34*(1),

Marcellin, P., et al. (2005). Treatment of chronic hepatitis B. *Rev Prat, 55*(6), 624-632.

positive chronic hepatitis B. *N Engl J Med, 348*(9), 808-816.

review of the literature. *Curr Gastroenterol Rep, 4*(1), 79-83.

chronic hepatitis B. *N Engl J Med, 359*(23), 2442-2455.

chronic liver disease. *Liver Transpl, 12*(1), 22-23.

liver disease. *Dig Liver Dis, 37*(11), 819-820.

minor liver resection. *Surgery, 142*, 676-684.

antigen-negative patients developing resistance to lamivudine. *Aliment Pharmacol* 

associated with poor health-related quality of life of patients with cirrhosis.

366.

1063.

140-147.

205.

*J Med, 10*(4), 91.

*Ther, 27*(3), 266-273.

*Gastroenterology, 120*, 170-178.

S18-20; discussion S21-13.

*Decis Making, 28*(4), 582-592.

*Hepatol, 15*(12), 1356-1361.

who to treat. *Am J Gastroenterol, 101 Suppl 1*, S7-12.

levels. *Aust N Z J Public Health, 25*(4), 355-361.

on Health Outcomes.


Reviews on the Epidemiology, Quality of Life, and Management of Chronic Hepatitis B (CHB) 401

Ware, J. E. J., et al. (1999). Health-related quality of life in chronic hepatitis C: impact of

Weinstein, M. C. (1990). Principles of cost-effective resource allocation in health care

Weinstein, M. C., et al. (1996). Recommendations of the Panel on Cost-effectiveness in

Wilson, J. M. G., & Jungner, G. (1968). *Principles and Practice of Screening for Disease.* Geneva:

Wong, I. O., et al. (2007). Cost effectiveness of mammography screening for Chinese women.

Wright, T. L. (2006). Introduction to chronic hepatitis B infection. *Am J Gastroenterol, 101* 

Wu, C. H., et al. (2003). Preliminary Use of the CLDQ in Chronic Hepatitis B Patients. *Chin J* 

Yacavone, R. F., et al. (2001). Quality of life measurement in gastroenterology: what is

Yeo B. (2008). Monthly Index of Medical Specialties (MIMS). from http://www.mims.com/ Yi, L. X. (2006). Effect of lamivudine treatment on the quality of life of chronic hepatitis B. *J* 

Ying, A. C. H. (2009). Guidelines on Cancer Prevention, Early Detection & Screening - Liver

Younossi, Z. M. (2001). Chronic liver disease and health-related quality of life.

Younossi, Z. M., et al. (2001). Health-related quality of life in chronic liver disease: the impact of type and severity of disease. *J Gastroenterol, 96*, 2199-2205. Younossi, Z. M., & Guyatt, G. (1998). Quality-of-life assessments and chronic liver disease.

Younossi, Z. M., et al. (1999). Development of a disease specific questionnaire to measure

Younossi, Z. M., et al. (2000). Cholestatic liver diseases and health-related quality of life. *Am* 

Yuan, Y., et al. (2008). Economic implications of entecavir treatment in suppressing viral

Yuen, M. F. (2007). Revisiting the natural history of chronic hepatitis B: impact of new concepts on clinical management. *J Gastroenterol Hepatol, 22*(7), 973-976. Yuen, M. F., & Lai, C. L. (2001). Treatment of chronic hepatitis B. *Lancet Infect Dis, 1*(4), 232-

Yuen, M. F., & Lai, C. L. (2003). Screening for hepatocellular carcinoma: survival benefit and

Chinese Social Security program. *Value Health, 11 Suppl 1*, S11-22.

cost-effectiveness. *Ann Oncol, 14*(10), 1463-1467.

health related quality of life in patients with chronic liver disease. *Gut, 45*(2), 295-

replication in chronic hepatitis B (CHB) patients in China from a perspective of the

http://www.hkacs.org.hk/content/anti\_cancer\_society.php?page=234

Weinstein, M. C., et al. (2009). QALYs: the basic. *Value Health, 12 (Suppl 1)*, S5-S9. WHO. (1947). Constitution of the World Health Organization. Geneva: WHO.

Health and Medicine. *Jama, 276*(15), 1253-1258.

available? *Am J Gastroenterol, 96*(2), 285-297.

*Cent South Univ (Med Sci), 31*, 396-399.

*Gastroenterology, 120*(1), 305-307.

*Am J Gastroenterol, 93*(7), 1037-1041.

*J Gastroenterol, 95*, 497-502.

550-555.

WHO.

*Suppl 1*, S1-6.

Cancer. from

300.

241.

*Cancer, 110*(4), 885-895.

*Clin Psychol, 11*(1), 60-62.

disease and treatment response. The Interventional Therapy Group. *Hepatology, 30*,

organizations. *International Journal of Technology Assessment in Health Care, 6*, 93-103.


Schipper, H., et al. (1996). Quality of life and pharmacoeconomics in clinical trials *Quality of* 

Singh, J. A., & Nelson, D. B. (2005). Health-related quality of life predicts future health care

Sobhonslidsuk, A., et al. (2004). Chronic liver disease questionnaire: translation and

Sobhonslidsuk, A., et al. (2006). Factors influencing health-related quality of life in chronic

Spiegel, B. M., et al. (2007). Development and validation of a disease-targeted quality of life

Spiegel, B. M., et al. (2005). Impact of hepatitis C on health related quality of life: a systematic review and quantitative assessment. *Hepatology, 41*(4), 790-800. Strauss, E., & Dias Teixeira, M. C. (2006). Quality of life in hepatitis C. *Liver Int, 26*(7), 755-

Sullivan, S. D., et al. (2007). Cost-effectiveness of peginterferon alpha-2a compared to

Sumskiene, J., et al. (2006). Disease-specific health-related quality of life and its determinants in liver cirrhosis patients in Lithuania. *World J Gastroenterol, 12*(48), 7792-7797. Sun, X., et al. (2007). Comparative cost-effectiveness of antiviral therapies in patients with

Takeda, A., et al. (2007). A systematic review and economic evaluation of adefovir dipivoxil

Tan, N. C., et al. (2008). Patients with chronic hepatitis B infection: what is their quality of

Thein, H. H., et al. (2005). Estimation of utilities for chronic hepatitis C from SF-36 scores.

Unal, G., et al. (2001). A psychometric comparison of health-related quality of life measures

van der Plas, S. M., et al. (2004). The Liver Disease Symptom Index 2.0; validation of a

van der Poorten, D., et al. (2007). Combination adefovir-lamivudine prevents emergence of

Veenstra, D. L., et al. (2008). Evaluating anti-viral drug selection and treatment duration in

adefovir resistance in lamivudine-resistant hepatitis B. *J Gastroenterol Hepatol, 22*(9),

HBeAg-negative chronic hepatitis B: a cost-effectiveness analysis. *Aliment Pharmacol* 

hepatitis B in Taiwan. *J Gastroenterol Hepatol, 22*(9), 1494-1499.

validation in Thais. *World J Gastroenterol, 10*(13), 1954-1957.

liver disease. *World J Gastroenterol, 12*, 7786-7791.

1.0. *Hepatology, 46*(1), 113-121.

*Hepatol, 22*(9), 1369-1377.

life? *Singapore Med J, 49*(9), 682-687.

*Am J Gastroenterol, 100*(3), 643-651.

in chronic liver disease. *J Clin Epidemiol, 54*, 587-596.

disease-specific questionnaire. *Qual Life Res, 13*, 1469-1481.

*Hepat, 14*(2), 75-88.

1500-1505.

*Ther*.

Lippincott-Raven.

755-765.

765.

*life studies. Definition and conceptual issues.* (2nd ed., pp. 11-24). Philadelphia:

utilization and mortality in veterans with self-reported physician-diagnosed arthritis: the veterans arthritis quality of life study. *Semin Arthritis Rheum, 34*(5),

instrument in chronic hepatitis B: the hepatitis B quality of life instrument, version

lamivudine treatment in patients with hepatitis B e antigen positive chronic

chronic hepatitis B: a systematic review of economic evidence. *J Gastroenterol* 

and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B. *J Viral* 


http://www.hkacs.org.hk/content/anti\_cancer\_society.php?page=234


Yuen, M. F., et al. (2007). Long-term lamivudine therapy reduces the risk of long-term

Yuen, M. F., et al. (2005). Prognostic determinants for chronic hepatitis B in Asians:

Zoulim, F., & Perrillo, R. (2008). Hepatitis B: reflections on the current approach to antiviral

disease. *Antivir Ther, 12*(8), 1295-1303.

therapy. *J Hepatol, 48 Suppl 1*, S2-19.

therapeutic implications. *Gut, 54*, 1610-1614.

complications of chronic hepatitis B infection even in patients without advanced
