Chronic Hepatitis C and Health-Related Quality of Life in Patients with Cognitive Impairment

Dear Editor, We have read the article by Rei et al. [1] about healthrelated quality of life valuation in patients with hepatitis C virus (HCV) infection. While we agree that it contributes to the subject knowledge, we think the selection of patients should be further discussed. The authors state that the presence of low cognitive level is part of the exclusion criteria. We understand that this criterion is important as it relates to the capacity of patients to answer and value their own health states; however, this leads to a lower representativeness of the study population within the whole population with HCV, especially when considering that cognitive alteration is a usual complication of chronic HCV infection [2]. Therefore, we believe that this population should not be excluded as it is important to consider their health-related quality of life as necessary information for their care and also for developing cost-utility studies. We propose that the authors could interview caregivers of these patients as a viable alternative. For example, Kahle-Wrobleski et al. [3] have considered the caregiver (person who knows and has contact with the patient at least 10 h per week) as a good source to valuation of the quality of life in patients with Alzheimer disease or dementia. Sneeuw et al. [4] did a review of 23 studies on health-related quality of life published between 1991 and 2000 and concluded that the coincidence between patient and proxy was moderate to high and the difference of quality of life reported was modest (median of 0.2). We also recommended another option, which would be to develop an instrument for patients with chronic diseases, like HVC infection, and cognitive impairment,