We greatly appreciated the thought-provoking comments provided by Drs Kappus and Bajaj[1, 2] regarding our paper describing the development of the HCVSTat instrument to assess treatment satisfaction in patients with chronic hepatitis C virus.[1, 2]

While the development of disease-specific instruments to assess patient-reported outcomes (PROs) such as treatment satisfaction is a rigorous undertaking, clinicians who wish to use these instruments as a tool to foster patient-centred relationships must be aware that newly developed PRO instruments have boundaries. As with this study, the complexities (e.g. mental health issues, comorbidities, drug use and genotype issues) associated with the HCV population often continue to be barriers to hepatitis C treatment.[3]

As a result, efforts to ensure that these patients are recruited into clinical trials and well represented in instrument development are not without challenges. Although responses to the HCVSTat were elicited from 79% of the patients who completed therapy in the past, responses elicited for treatment satisfaction from the other 21% of patients may be subject to change during the course of therapy and after therapy was completed.

However, patient satisfaction criteria should be conceptually universal, regardless of experience with currently available modalities. While current treatments may not appeal to patients, attributes that would constitute a satisfactory treatment should nevertheless be identifiable. The focus groups used in this study permitted patients to identify those attributes.

Opportunities to meld both the qualitative and quantitative aspects of data collection and analysis as part of a rigorous process to establish the reliability and validity of the HCVSTat instrument will ensure optimal instrument performance (i.e. the ability to link patient responses with clinical measures for the purposes of predicting treatment satisfaction) in future studies.


  1. Top of page
  2. Acknowledgement
  3. References

The authors’ declarations of personal and financial interests are unchanged from those in the original article.2


  1. Top of page
  2. Acknowledgement
  3. References
  • 1
    Kappus MR, Bajaj JS. Commentary: the chronic hepatitis C virus treatment satisfaction (HCVTSat) instrument. Aliment Pharmacol Ther 2013; 37: 750.
  • 2
    Szeinbach SL, Baran RW, Dietz B, Gazzuola Rocca L, Littlefield D, Yawn BP. Development and validation of the chronic hepatitis C virus treatment satisfaction (HCVTSat) instrument. Aliment Pharmacol Ther 2013; 37: 57382.
  • 3
    Yawn BP, Gazzouola Rocca L, Wollan PC. Ten year trends in the diagnosis and treatment of hepatitis C and concomitant mental health disorders: 1995 to 2005. Prim Care Companion J Clin Psychiatry 2008; 10: 34954.