Development of a Patient-Reported Outcome Measure for Non-Alcoholic Steatohepatitis (NASH-CHECK): Results of a Qualitative Study

Lynda C. Doward (), Maria-Magdalena Balp (), James Twiss (), Christina Slota (), Donna Cryer (), Clifford A. Brass (), Quentin M. Anstee () and Arun J. Sanyal ()
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Lynda C. Doward: RTI Health Solutions
Maria-Magdalena Balp: Novartis Pharma AG
James Twiss: RTI Health Solutions
Christina Slota: RTI Health Solutions
Donna Cryer: Global Liver Institute
Clifford A. Brass: Novartis Pharmaceuticals, Inc.
Quentin M. Anstee: Newcastle University
Arun J. Sanyal: Virginia Commonwealth University

The Patient: Patient-Centered Outcomes Research, 2021, vol. 14, issue 5, No 7, 533-543

Abstract: Abstract Background Non-alcoholic steatohepatitis (NASH) is a progressive form of non-alcoholic fatty liver disease characterized by excessive liver fat accumulation, inflammation, cell injury, and fibrosis. It is viewed as largely asymptomatic in its earlier (non-cirrhotic) stages, and information on the patient-perceived impact of NASH is scarce. Objective This study aimed to develop a NASH-specific patient-reported outcome (PRO) measure (NASH-CHECK) for use as a trial endpoint, using methods compliant with regulatory expectations. Methods A NASH conceptual model was developed based on the literature and clinical/patient expert review. The model guided concept elicitation (CE) interviews in patients with non-cirrhotic NASH recruited via a US tertiary care center. NASH-CHECK content was generated via thematic analysis of CE data and review by clinical/patient experts. Cognitive debriefing (CD) interviews with US patients evaluated content validity. Results The literature review confirmed that NASH impacts on functioning and health-related quality of life (HRQoL). Overall, 23 CE and 20 CD interviews were conducted. Key symptoms reported in CE interviews included pain in the upper-right abdomen (n = 14), fatigue (n = 18), poor sleep quality (n = 12), impaired memory (n = 13), and reduced focus (n = 11); key HRQoL impacts included impaired physical functioning, reduced ability to conduct daily living tasks, reduced quality of relationships, low mood, anxiety, and self-consciousness. The 52-item first-draft NASH-CHECK was reduced to 31 items based on patient feedback on item relevance, acceptability, and comprehension. Conclusions The interviews revealed key symptoms and broad HRQoL impacts of NASH. As a disease-specific PRO measure assessing symptoms and HRQoL, the NASH-CHECK is relevant, comprehensive, and acceptable to patients and clinicians.

Date: 2021
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DOI: 10.1007/s40271-020-00485-w

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