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Health and Quality of Life Outcomes

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Open Access 01-12-2009 | Research

Cognitive impairment and preferences for current health

Authors: Joseph T King Jr, Joel Tsevat, Mark S Roberts

Published in: Health and Quality of Life Outcomes | Issue 1/2009

Abstract

Background

We assessed preferences for current health using the visual analogue scale (VAS), standard gamble (SG), time trade-off (TTO), and willingness to pay (WTP) in patients with cerebral aneurysms, a population vulnerable to cognitive deficits related to aneurysm bleeding or treatment.

Methods

We measured VAS, SG, TTO, and WTP values for current health in 165 outpatients with cerebral aneurysms. We assessed cognitive impairment with the Mini Mental State Examination (MMSE; scores < 24 = cognitive impairment). We examined the distributions of preference responses stratified by cognitive status, and the relationship between preferences and cognitive impairment, patient characteristics, and aneurysm history.

Results

Eleven patients (7%) had MMSE scores < 24. The distribution of preferences responses from patients with cognitive impairment had greater variance (SG, 0.39 vs. 0.21, P = 0.001; TTO, 0.36 vs. 0.24, P = 0.017) and altered morphology (VAS, P = 0.012; SG, P = 0.023) compared to the responses of unimpaired patients. There was good correlation between most preference measures for unimpaired patients (VAS:TTO, rho = 0.19, P = 0.018; SG:TTO, rho = 0.36, P < 0.001; SG:WTP, rho = -0.33, P < 0.001) and a trend towards significance with another pairing (VAS:WTP, rho = 0.16, P = 0.054). In subjects with cognitive impairment, there was a significant correlation only between VAS and TTO scores (rho = 0.76, P = 0.023). Separate regression models showed that cognitive impairment was associated with lower preferences on the VAS (β = -0.12, P = 0.048), SG (β = -0.23, P = 0.002), and TTO (β = -0.17, P = 0.035).

Conclusion

Cognitive impairment is associated with lower preferences for current health in patients with cerebral aneurysms. Cognitively impaired patients have poor inter-preference test correlations and different response distributions compared to unimpaired patients.

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Streiner DL, Norman GR: Health Measurement Scales. A practical guide to their development and use. New York: Oxford University Press; 1989.

von Neumann J, Morgenstern O: Theory of Games and Economic Behavior. New York: Wiley; 1953.

Torrance GW, Thomas WH, Sackett DL: A utility maximization model for evaluation of health care programs. Health Serv Res 1972, 7: 118–133.PubMed

Diener A, O'Brien B, Gafni A: Health care contingent valuation studies: a review and classification of the literature. Health Econ 1998, 7: 313–326. 10.1002/(SICI)1099-1050(199806)7:4<313::AID-HEC350>3.0.CO;2-BCrossRefPubMed

Rinkel GJ, Djibuti M, Algra A, van GJ: Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 1998, 29: 251–256.CrossRefPubMed

McCormick WF, Nofzinger JD: Saccular intracranial aneurysms: an autopsy study. J Neurosurg 1965, 22: 155–159.CrossRefPubMed

Inagawa T, Hirano A: Autopsy study of unruptured incidental intracranial aneurysms. Surg Neurol 1990, 34: 361–365. 10.1016/0090-3019(90)90237-JCrossRefPubMed

Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, et al.: Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke 2002, 33: 200–208. 10.1161/hs0102.101080CrossRefPubMed

The International Study of Unruptured Intracranial Aneurysm Investigators: Unruptured intracranial aneurysms – risk of rupture and risks of surgical intervention. N Engl J Med 1998, 339: 1725–1733. 10.1056/NEJM199812103392401CrossRef

10.

Neumann PJ, Kuntz KM, Leon J, Araki SS, Hermann RC, Hsu MA, et al.: Health utilities in Alzheimer's disease: a cross-sectional study of patients and caregivers. Med Care 1999, 37: 27–32. 10.1097/00005650-199901000-00005CrossRefPubMed

11.

Jonsson L, Andreasen N, Kilander L, Soininen H, Waldemar G, Nygaard H, et al.: Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Dis Assoc Disord 2006, 20: 49–55. 10.1097/01.wad.0000201851.52707.c9CrossRefPubMed

12.

Ekman M, Berg J, Wimo A, Jonsson L, McBurney C: Health utilities in mild cognitive impairment and dementia: a population study in Sweden. Int J Geriatr Psychiatry 2006,22(7):649–655. 10.1002/gps.1725CrossRef

13.

Bravata DM, Nelson LM, Garber AM, Goldstein MK: Invariance and inconsistency in utility ratings. Med Decis Making 2005, 25: 158–167. 10.1177/0272989X05275399CrossRefPubMed

14.

Lenert LA, Michelson D, Flowers C, Bergen MR: IMPACT: an object-oriented graphical environment for construction of multimedia patient interviewing software. Proc Annu Symp Comput Appl Med Care 1995, 319–323.

15.

Lenert LA, Cher DJ, Goldstein MK, Bergen MR, Garber A: The effect of search procedures on utility elicitations. Med Decis Making 1998, 18: 76–83. 10.1177/0272989X9801800115CrossRefPubMed

16.

Folstein MF, Folstein SE, McHugh PR: "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189–198. 10.1016/0022-3956(75)90026-6CrossRefPubMed

17.

Kim DH, Haney CL, Van GG: Utility of outcome measures after treatment for intracranial aneurysms: a prospective trial involving 520 patients. Stroke 2005, 36: 792–796. 10.1161/01.STR.0000157594.58180.97CrossRefPubMed

18.

Nozaki T, Sakai N, Oishi H, Nishizawa S, Namba H: Cholinergic dysfunction in cognitive impairments after aneurysmal subarachnoid hemorrhage. Neurosurg 2002, 51: 944–947. 10.1097/00006123-200210000-00016

19.

Saciri BM, Kos N: Aneurysmal subarachnoid haemorrhage: outcomes of early rehabilitation after surgical repair of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 2002, 72: 334–337. 10.1136/jnnp.72.3.334CrossRefPubMed

20.

King JT Jr, DiLuna ML, Cicchetti DV, Tsevat J, Roberts MS: Cognitive functioning in patients with cerebral aneurysms measured with the mini mental state examination and the telephone interview for cognitive status. Neurosurg 2006, 59: 803–810. 10.1227/01.NEU.0000232666.67779.41CrossRef

21.

Fryback DG, Dasback EJ, Klein R, Klein BEK, Peterson K, Martin PA: The Beaver Dam health outcomes study: Initial catalog of health-state quality factors. Med Decis Making 1993, 13: 89–102. 10.1177/0272989X9301300202CrossRefPubMed

22.

Kind P, Dolan P, Gudex C, Williams A: Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ 1998, 316: 736–741.CrossRefPubMed

23.

Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-effectiveness in Health and Medicine. New York: Oxford University Press; 1996.

24.

Neumann PJ, Goldie SJ, Weinstein MC: Preference-based measures in economic evaluation in health care. Annu Rev Public Health 2000, 21: 587–611. 10.1146/annurev.publhealth.21.1.587CrossRefPubMed

25.

Stiggelbout AM, Kiebert GM, Kievit J, Leer JW, Stoter G, De Haes JC: Utility assessment in cancer patients: adjustment of time tradeoff scores for the utility of life years and comparison with standard gamble scores. Med Decis Making 1994, 14: 82–90. 10.1177/0272989X9401400110CrossRefPubMed

26.

Bremner KE, Chong CA, Tomlinson G, Alibhai SM, Krahn MD: A review and meta-analysis of prostate cancer utilities. Med Decis Making 2007, 27: 288–298. 10.1177/0272989X07300604CrossRefPubMed

27.

Gabriel SE, Kneeland TS, Melton LJ III, Moncur MM, Ettinger B, Tosteson AN: Health-related quality of life in economic evaluations for osteoporosis: whose values should we use? Med Decis Making 1999, 19: 141–148. 10.1177/0272989X9901900204CrossRefPubMed

28.

Sackett DL, Torrance GW: The utility of different health states as perceived by the general public. J Chronic Disorders 1978, 31: 697–704. 10.1016/0021-9681(78)90072-3CrossRef

29.

Polsky D, Willke RJ, Scott K, Schulman KA, Glick HA: A comparison of scoring weights for the EuroQol derived from patients and the general public. Health Econ 2001, 10: 27–37. 10.1002/1099-1050(200101)10:1<27::AID-HEC561>3.0.CO;2-RCrossRefPubMed

30.

Fryback DG, Lawrence WF, Martin PA, Klein R, Klein BE: Predicting Quality of Well-being scores from the SF-36: results from the Beaver Dam Health Outcomes Study. Med Decis Making 1997, 17: 1–9. 10.1177/0272989X9701700101CrossRefPubMed

31.

Torrance GW, Furlong WJ, Feeny D, Boyle MH: Multi-attribute preference functions: health utilities index. PharmacoEconomics 1995, 9: 503–520. 10.2165/00019053-199507060-00005CrossRef

32.

King JT Jr, Styn MA, Tsevat J, Roberts MS: "Perfect health" versus "disease free": the impact of anchor point choice on the measurement of preferences and the calculation of disease-specific disutilities. Med Decis Making 2003, 23: 212–225. 10.1177/0272989X03023003003CrossRefPubMed

33.

Woloshin S, Schwartz LM, Moncur M, Gabriel S, Tosteson AN: Assessing values for health: numeracy matters. Med Decis Making 2001, 21: 382–390. 10.1177/02729890122062686CrossRefPubMed

34.

Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA: Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol 2003, 60: 1119–1122. 10.1001/archneur.60.8.1119CrossRefPubMed

35.

Kukull WA, Larson EB, Teri L, Bowen J, McCormick W, Pfanschmidt ML: The Mini-Mental State Examination score and the clinical diagnosis of dementia. J Clin Epidemiol 1994, 47: 1061–1067. 10.1016/0895-4356(94)90122-8CrossRefPubMed

36.

Monsch AU, Foldi NS, Ermini-Funfschilling DE, Berres M, Taylor KI, Seifritz E, et al.: Improving the diagnostic accuracy of the Mini-Mental State Examination. Acta Neurol Scand 1995, 92: 145–150.CrossRefPubMed

37.

Nelson A, Fogel BS, Faust D: Bedside cognitive screening instruments. A critical assessment. J Nerv Ment Dis 1986, 174: 73–83. 10.1097/00005053-198602000-00002CrossRefPubMed

38.

Brandt J, Spencer M, Folstein MF: The telephone interview for cognitive status. Neuropsychiatr Neuropsychol Behav Neurol 1988, 1: 111–117.

39.

SUPPORT: Study to understand prognoses and preferences for outcomes and risks of treatments. Study design J Clin Epidemiol 1990,43(Suppl):1S-123S.

40.

Tsevat J, Dawson NV, Wu AW, Lynn J, Soukup JR, Cook EF: Health values of hospitalized patients 80 years or older. JAMA 1998, 279: 371–375. 10.1001/jama.279.5.371CrossRefPubMed

41.

Lenert LA, Sturley A, Rupnow M: Toward improved methods for measurement of utility: automated repair of errors in elicitations. Med Decis Making 2003, 23: 67–75. 10.1177/0272989X02239649CrossRefPubMed

42.

Tversky A, Kahneman D: The framing of decision and the psychology of choice. Science 1981, 211: 453–458. 10.1126/science.7455683CrossRefPubMed

43.

Llewellyn-Thomas H, Sutherland HJ, Tibshirani R, Ciampi A, Till JE, Boyd NF: The measurement of patients' values in medicine. Med Decis Making 1982, 2: 449–462. 10.1177/0272989X8200200407CrossRefPubMed

44.

Wakker P, Stiggelbout A: Explaining distortions in utility elicitation through the rank-dependent model for risky choices. Med Decis Making 1995, 15: 180–186. 10.1177/0272989X9501500212CrossRefPubMed

45.

Torrance GW, Boyle MH, Horwood SP: Application of multi-attribute theory to measure social preference for health states. Operations Res 1982, 30: 1043–1069. 10.1287/opre.30.6.1043CrossRef

46.

Johannesson M, Pliskin JS, Weinstein MC: A note on QALYs, time tradeoff, and discounting. Med Decis Making 1994, 14: 188–193. 10.1177/0272989X9401400212CrossRefPubMed

47.

Nord E: Methods for quality adjustment of life years. Soc Sci Med 1992, 34: 559–569. 10.1016/0277-9536(92)90211-8CrossRefPubMed

48.

Richardson J: Cost utility analysis: what should be measured? Soc Sci Med 1994, 39: 7–21. 10.1016/0277-9536(94)90162-7CrossRefPubMed

49.

Torrance GW, Feeny D, Furlong W: Visual analog scales: do they have a role in the measurement of preferences for health states? Med Decis Making 2001, 21: 329–334. 10.1177/02729890122062622CrossRefPubMed

50.

Stiggelbout AM: Assessing patient's preferences. In Decision Making in Health Care: Theory, Psychology, and Applications. Edited by: Chapman GB, Sonnenberg FA. Cambridge: Cambridge University Press; 2000:289–312.

51.

Gafni A: Willingness to pay. What's in a name? PharmacoEconomics 1998, 14: 465–470. 10.2165/00019053-199814050-00001CrossRefPubMed

52.

King JT Jr, Tsevat J, Lave JR, Roberts MS: Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation. Med Decis Making 2005, 25: 667–677. 10.1177/0272989X05282640CrossRefPubMed

53.

Paulino Ramirez DS, Gil GP, Manuel Ribera CJ, Reynish E, Jean OP, Vellas B, et al.: The need for a consensus in the use of assessment tools for Alzheimer's disease: the Feasibility Study (assessment tools for dementia in Alzheimer Centres across Europe), a European Alzheimer's Disease Consortium's (EADC) survey. Int J Geriatr Psychiatry 2005, 20: 744–748. 10.1002/gps.1355CrossRef

54.

Small GW, Kaufer D, Mendiondo MS, Quarg P, Spiegel R: Cognitive performance in Alzheimer's disease patients receiving rivastigmine for up to 5 years. Int J Clin Pract 2005, 59: 473–477. 10.1111/j.1368-5031.2005.00524.xCrossRefPubMed

Title: Cognitive impairment and preferences for current health
Authors: Joseph T King Jr
Joel Tsevat
Mark S Roberts
Publication date: 01-12-2009
Publisher: BioMed Central
Published in: Health and Quality of Life Outcomes / Issue 1/2009
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/1477-7525-7-1

At a glance: The STEP trials

Springer Medicine

Cognitive impairment and preferences for current health

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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