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Ali, Myzoon, MacIsaac, Rachael, Quinn, Terence J., Bath, Philip M.W., Veenstra, David L., Xu, Yaping, Brady, Marian C., Patel, Anita and Lees, Kennedy R. (2017) Dependency and health utilities in stroke: data to inform cost-effectiveness analyses. European Stroke Journal, 2 (1). pp. 70-76. ISSN 2396-9873

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Abstract

Introduction: Health utilities (HU) assign preference weights to specific health states and are required for costeffectiveness 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.

Item Type:	Article
Keywords:	Stroke, trial, health utility, EQ-5D, cost effectiveness, modified Rankin Scale, quality of life
Schools/Departments:	University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Clinical Neuroscience
Identification Number:	https://doi.org/10.1177/2396987316683780
Depositing User:	Eprints, Support
Date Deposited:	16 Aug 2017 10:59
Last Modified:	23 Jan 2018 18:55
URI:	https://eprints.nottingham.ac.uk/id/eprint/44946

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