Dependency and health utilities in stroke: Data to inform cost-effectiveness analyses

on behalf of the VISTA Collaborators

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Introduction: Health utilities (HU) assign preference weights to specific health states and are required for cost-effectiveness analyses. Existing HU for stroke inadequately reflect the spectrum of post-stroke disability. Using international stroke trial data, we calculated HU stratified by disability to improve precision in future cost-effectiveness analyses. Materials and methods: We used European Quality of Life Score (EQ-5D-3L) data from the Virtual International Stroke Trials Archive (VISTA) to calculate HU, stratified by modified Rankin Scale scores (mRS) at 3 months. We applied published value sets to generate HU, and validated these using ordinary least squares regression, adjusting for age and baseline National Institutes of Health Stroke Scale (NIHSS) scores. Results: We included 3858 patients with acute ischemic stroke in our analysis (mean age: 67.5 ± 12.5, baseline NIHSS: 12 ± 5). We derived HU using value sets from 13 countries and observed significant international variation in HU distributions (Wilcoxon signed-rank test p < 0.0001, compared with UK values). For mRS = 0, mean HU ranged from 0.88 to 0.95; for mRS = 5, mean HU ranged from −0.48 to 0.22. OLS regression generated comparable HU (for mRS = 0, HU ranged from 0.9 to 0.95; for mRS = 5, HU ranged from −0.33 to 0.15). Patients’ mRS scores at 3 months accounted for 65–71% of variation in the generated HU. Conclusion: We have generated HU stratified by dependency level, using a common trial endpoint, and describing expected variability when applying diverse value sets to an international population. These will improve future cost-effectiveness analyses. However, care should be taken to select appropriate value sets.

Original languageEnglish (US)
Pages (from-to)70-76
Number of pages7
JournalEuropean Stroke Journal
Volume2
Issue number1
DOIs
StatePublished - Mar 1 2017

Keywords

  • EQ-5D
  • Stroke
  • cost effectiveness
  • health utility
  • modified Rankin Scale
  • quality of life
  • trial

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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