Health-Related Quality of Life After Stroke A Comprehensive Review

Abstract

Background and Purpose-We performed a comprehensive review of all quality-of-life (QOL) estimates for stroke appearing in the peer-reviewed literature between 1985 and 2000. We examine variation in QOL weights and the rigor of methods used to assess QOL and discuss the implications for cost-utility assessment and resource allocation decisions. Methods-Through a systematic search, we identified 67 articles that met our inclusion criteria. A team of trained researchers read each article and followed detailed guidelines to extract QOL weights and other parameters. This effort yielded 161 QOL estimates for stroke-related health states. All estimates were measured on a 0 to 1 scale, with 0 representing the worst outcome and 1 representing the best. Results-QOL estimates range from Ϫ0.02 to 0.71 (nϭ67) for major stroke, from 0.12 to 0.81 (nϭ14) for moderate stroke, from 0.45 to 0.92 (nϭ38) for minor stroke, and from 0.29 to 0.903 (nϭ42) for general stroke. Although QOL should decrease with severity, there were many instances in which the QOL for major stroke as reported by one study exceeded the QOL for moderate stroke as reported by another. The same reversal was found for moderate and minor stroke, and it occurred even when both authors used similar assessment methods and subject populations. Authors of cost-utility and decision analyses rarely base their choice of QOL weights on their own primary data (19%). When obtaining weights from secondary sources, some authors (23%) chose QOL weights for a severity of stroke that did not match the severity for which they sought data. Conclusions-QOL estimates for stroke vary greatly and are not always estimated in sound fashion. This impedes the comparability and quality of the cost-effectiveness studies that use these QOL weights and hampers good resource allocation decisions.

Accurate, practical and cost-effective assessment of carotid stenosis in the UK

“…194 The first review included 67 articles. 192 Quality of life estimates ranged from -0.02 to 0.71 for major stroke (n = 67), from 0.12 to 0.81 (n = 14) for moderate stroke, from 0.45 to 0.92 for minor stroke, and from 0.29 to 0.903 for any stroke. An important difference between the estimates was 145 that is, whether patients valued their own state or valued hypothetical condition-specific or generic states.…”

“…192,193 It is currently recommended for economic valuation that health state utility values should be obtained using a choice-based technique such as standard gamble (SG) or time trade-off (TTO) rather than a rating scale. 194 The first review included 67 articles.…”

Clinical effectiveness and cost-effectiveness of clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events: a systematic review and economic evaluation

“…82 The review reports the results of 67 studies which provide 161 utility estimates for stroke. The model uses the median value from the range of utilities presented for minor, moderate and major stroke.…”

“…The studies used in Tengs and colleagues' review 82 were available on request from the author. By reviewing these, it is revealed that the utility of major stroke of 0.36 applied in the model was that reported in a study using an RS in members of the community.…”

The Modern View on the Problem of the Quality of Life in Patients with Ischemic Stroke

“…Некоторые авторы используют порядко-вую шкалу тяжести инсульта Rankin, где зна-чение «0» присваивается бессимптомному инсульту, а значение «6» -смертельному по-ражению (Tengs et al, 2001) 2008) от-метили, что наихудшие показатели качества жизни были выявлены у пациентов, перенес-ших обширные инсульты в бассейне передней мозговой артерии, а также при наличии пато-логии эмболической этиологии. Отрицательно влияющими на качество жизни факторами являются депрессия и большой объем потери серого вещества подкорковых ядер (Irimia, Van Horn, 2014).…”