Assessment of post-stroke quality of life in cost-effectiveness studies: the usefulness of the Barthel Index and the EuroQoL-5D.
Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. We address the problem of estimating quality adjusted life years (QALYs) for use in cost-effectiveness studies of stroke interventions. In the acute phase after stroke--at stroke onset and during rehabilitation--many patients are physically or mentally not able to (self-)report their quality of life. Missing values may obviously bias cost-effectiveness results. We have examined the direct relationship between a conventional clinical scale of functional status that is suited for proxy-assessment (Barthel Index (BI)) and a measure of health related quality of life (EuroQoL-5D). Based on data collected within the framework of an evaluation of three stroke-service experiments in The Netherlands (n = 598, 6 month follow-up), we established a plausible and significant relationship between the measures. Health related quality of life (HRQoL) is -0.25 for patients with a BI of 0, and with each additional point HRQoL increases with 0.05. Independent patients (BI 20) get a HRQoL is 0.75, which corresponds to the general population reference score for our sample. BI scores may be used as proxy for HRQoL in case of missing values on EuroQoL-5D.
van Exel
N J A
NJ
Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands. vanexel@bmg.eur.nl
Scholte op Reimer
W J M
WJ
Koopmanschap
M A
MA
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019727:Proxy; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018434:Sickness Impact Profile; D020521:Stroke / Q000503:physiopathology / Q000523:psychology*; D011795:Surveys and Questionnaires