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Assessment of post-stroke quality of life in cost-effectiveness studies: The usefulness of the Barthel Index and the EuroQoL-5D

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Abstract

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.

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Authors and Affiliations

  1. Department of Health Policy and Management, Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands

    N.J.A. van Exel & M.A. Koopmanschap

  2. Department of Cardiology, Clinical Epidemiology, Thoraxcenter, Academic Hospital Rotterdam, Rotterdam, The Netherlands

    W.J.M. Scholte op Reimer

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  1. N.J.A. van Exel
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  2. W.J.M. Scholte op Reimer
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  3. M.A. Koopmanschap
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van Exel, N., Scholte op Reimer, W. & Koopmanschap, M. Assessment of post-stroke quality of life in cost-effectiveness studies: The usefulness of the Barthel Index and the EuroQoL-5D. Qual Life Res 13, 427–433 (2004). https://doi.org/10.1023/B:QURE.0000018496.02968.50

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