Top

Published in:

Open Access 01-11-2017

Long-term QALY-weights among spouses of dependent and independent midlife stroke survivors

Authors: Josefine Persson, Mattias Aronsson, Lukas Holmegaard, Petra Redfors, Kaj Stenlöf, Katarina Jood, Christina Jern, Christian Blomstrand, Gunilla Forsberg-Wärleby, Lars-Åke Levin

Published in: Quality of Life Research | Issue 11/2017

Abstract

Purpose

The aim of this study was to investigate whether the dependency of midlife stroke survivors had any long-term impact on their spouses’ QALY-weights.

Method

Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. Health-related quality of life was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. Spouses of dependent and independent stroke survivors were categorized according to their scores on the modified Rankin Scale. An ordinary least squares regression analysis was used to evaluate whether the dependency of the stroke survivors had any impact on the spouses’ QALY-weights.

Result

Cohabitant dyads of 247 stroke survivors aged <70 at stroke onset and 245 dyads of controls were included in the study. Spouses of dependent stroke survivors (n = 50) reported a significant lower mean QALY-weight of 0.69 in comparison to spouses of independent stroke survivors (n = 197) and spouses of controls, (n = 245) who both reported a mean QALY-weight of 0.77. The results from the regression analysis showed that higher age of the spouse and dependency of the stroke survivor had a negative association with the spouses’ QALY-weights.

Conclusion

The QALY-weights for spouses of dependent midlife stroke survivors were significantly reduced compared to spouses of independent midlife stroke survivors. This indicates that the inclusion of spouses’ QALYs in evaluations of early treatment and rehabilitation efforts to reduce stroke patients’ dependency would capture more of the total effect in dyads of stroke survivors.

Socialstyrelsen. Nationella riktlinjer för sjukdomsförebyggande metoder 2011—Hälsoekonomiskt underlag (Bilaga). [National guidelines for prevention methods 2011—Health economic evidence]. Socialstyrelsen, Stockholm. 2011. Retrieved January 19, 2017 from http://www.socialstyrelsen.se/nationellariktlinjerforsjukdomsforebyggandemetoder/Documents/nr-sjukdomsforebyggande-halsoekonomisktunderlag.pdf.

NICE. Guide to the methods of technology appraisal 2013. Retrieved January 19, 2017 from https://www.nice.org.uk/article/pmg9/resources/non-guidance-guide-to-the-methods-of-technology-appraisal-2013-pdf.

Gold, M., Siegel, J., Russell, L., & Weinstein, M. (1996). Cost-effectiveness in health and medicine. New York: Oxford University Press.

Claxton, K., Walker, S., Palmer, S., & Sculpher, M. Appropriate perspectives for healthcare decisions. In University of York CHE Research Paper 54. York, University of York, 2010. Retrieved January 19, 2017 from http://www.york.ac.uk/che/pdf/rp54.pdf.

Davidson, T., & Levin, L.-Å. (2010). Is the societal approach wide enough to include relatives? Incorporating relatives’ costs and effects in a cost-effectiveness analysis. Applied Health Economics and Health Policy, 8, 25–35.CrossRefPubMed

van den Berg, B., Brouwer, W. B., & Koopmanschap, M. A. (2004). Economic valuation of informal care. An overview of methods and applications. The European Journal of Health Economics, 5, 36–45.CrossRefPubMed

Al-Janabi, H., Flynn, T. N., & Coast, J. (2011). QALYs and carers. Pharmacoeconomics, 29, 1015–1023.CrossRefPubMed

Claesson, L., Gosman-Hedström, G., Johannesson, M., Fagerberg, B., & Blomstrand, C. (2000). Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients: The Goteborg 70+ stroke study. Stroke, 31, 2569–2577.CrossRefPubMed

Forsberg-Warleby, G., Moller, A., & Blomstrand, C. (2004). Life satisfaction in spouses of patients with stroke during the first year after stroke. Journal of Rehabilitation Medicine, 36, 4–11.CrossRefPubMed

10.

Green, T. L., & King, K. M. (2007). The trajectory of minor stroke recovery for men and their female spousal caregivers: Literature review. Journal of Advanced Nursing, 58, 517–531.CrossRefPubMed

11.

Saban, K. L., Sherwood, P. R., DeVon, H. A., & Hynes, D. M. (2010). Measures of psychological stress and physical health in family caregivers of stroke survivors: A literature review. Journal of Neuroscience Nursing, 42, 128–138.CrossRefPubMed

12.

Persson, J., Holmegaard, L., Karlberg, I., Redfors, P., Jood, K., et al. (2015). Spouses of stroke survivors report reduced health-related quality of life even in long-term follow-up: Results from Sahlgrenska Academy Study on Ischemic Stroke. Stroke, 46, 2584–2590.CrossRefPubMed

13.

Jood, K., Ladenvall, C., Rosengren, A., & Blomstrand, C. (2005). Family history in ischemic stroke before 70 years of age: The Sahlgrenska Academy Study on Ischemic Stroke. Stroke, 36, 1383–1387.CrossRefPubMed

14.

Sullivan, M., & Karlsson, J. (1998). The Swedish SF-36 Health Survey III. Evaluation of criterion-based validity: Results from normative population. Journal of Clinical Epidemiology, 51, 1105–1113.CrossRefPubMed

15.

Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21, 271–292.CrossRefPubMed

16.

van Swieten, J. C., Koudstaal, P. J., Visser, M. C., Schouten, H. J., & van Gijn, J. (1988). Interobserver agreement for the assessment of handicap in stroke patients. Stroke, 19, 604–607.CrossRefPubMed

17.

Sulter, G., Steen, C., & De Keyser, J. (1999). Use of the Barthel index and modified Rankin Scale in acute stroke trials. Stroke, 30, 1538–1541.CrossRefPubMed

18.

Goldstein, L. B., Bertels, C., & Davis, J. N. (1989). Interrater reliability of the NIH stroke scale. Archives of Neurology, 46, 660–662.CrossRefPubMed

19.

Granger, C. V., Dewis, L. S., Peters, N. C., Sherwood, C. C., & Barrett, J. E. (1979). Stroke rehabilitation: Analysis of repeated Barthel index measures. Archives of Physical Medicine and Rehabilitation, 60, 14–17.PubMed

20.

Prigatano, G. P. (1991). BNI Screen for higher cerebral functions: Rationale and initial validation. BNI Quart., 7, 2–9.

21.

Denvall, V., Elmståhl, S., & Prigatano, G. P. (2002). Replication and construct validation of the Barrow Neurological Institute Screen for Higher Cerebral Function with a Swedish population. Journal of Rehabilitation Medicine, 34, 153–157.CrossRefPubMed

22.

Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefPubMed

23.

Bursac, Z., Gauss, C. H., Williams, D. K., & Hosmer, D. W. (2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine, 3, 17.CrossRefPubMedPubMedCentral

24.

Walters, S. J., & Brazier, J. E. (2003). What is the relationship between the minimally important difference and health state utility values? The case of the SF-6D. Health and Quality of Life Outcomes, 1, 4.CrossRefPubMedPubMedCentral

25.

Wittenberg, E., & Prosser, L. A. (2013). Disutility of illness for caregivers and families: A systematic review of the literature. Pharmacoeconomics, 31, 489–500.CrossRefPubMedPubMedCentral

26.

Gupta, S., Isherwood, G., Jones, K., & Van Impe, K. (2015). Assessing health status in informal schizophrenia caregivers compared with health status in non-caregivers and caregivers of other conditions. BMC Psychiatry, 15, 162.CrossRefPubMedPubMedCentral

27.

Ågren, S., Evangelista, L., Davidson, T., & Strömberg, A. (2011). The influence of chronic heart failure in patient-partner dyads—a comparative study addressing issues of health-related quality of life. Journal of Cardiovascular Nursing, 26, 65–73.CrossRefPubMedPubMedCentral

28.

Patel, A., Knapp, M., Evans, A., Perez, I., & Kalra, L. (2004). Training care givers of stroke patients: Economic evaluation. BMJ, 328, 1102.CrossRefPubMedPubMedCentral

29.

Wilson, E., Thalanany, M., Shepstone, L., Charlesworth, G., Poland, F., Harvey, I., et al. (2009). Befriending carers of people with dementia: A cost utility analysis. International Journal of Geriatric Psychiatry, 24, 610–623.CrossRefPubMed

30.

van Stel, H. F., & Buskens, E. (2006). Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease. Health and Quality of Life Outcomes, 4, 20.CrossRefPubMedPubMedCentral

31.

Burström, K., Johannesson, M., & Diderichsen, F. (2001). Swedish population health-related quality of life results using the EQ-5D. Quality of Life Research, 10, 621–635.CrossRefPubMed

32.

Socialstyrelsen. Anhöriga som ger omsorg till närstående—omfattning och konsekvenser. [Caregivers providing care for realtives—magnitude and consequences]. Socialstyrelsen: Stockholm, 2012. Retreived January 19, 2017 http://www.socialstyrelsen.se/publikationer2012/2012-8-15.

33.

van Exel, N. J., Koopmanschap, M. A., van den Berg, B., Brouwer, W. B., & van den Bos, G. A. (2005). Burden of informal caregiving for stroke patients. Identification of caregivers at risk of adverse health effects. Cerebrovascular Diseases, 19, 11–17.CrossRefPubMed

34.

Hounsome, N., Orrell, M., & Edwards, R. (2011). EQ-5D as a quality of life measure in people with dementia and their carers: Evidence and key issues. Value in Health, 14, 390–399.CrossRefPubMed

35.

Al-Janabi, H., van Exel, J., Brouwer, W., & Coast, J. (2016). A framework for including family health spillover in economic evaluation. Medical Decision Making, 36, 176–186.CrossRefPubMedPubMedCentral

36.

Basu, A., & Meltzer, D. (2005). Implications of spillover effects within the family for medical cost-effectiveness analysis. Journal of Health Economics, 24, 751–773.CrossRefPubMed

Title: Long-term QALY-weights among spouses of dependent and independent midlife stroke survivors
Authors: Josefine Persson
Mattias Aronsson
Lukas Holmegaard
Petra Redfors
Kaj Stenlöf
Katarina Jood
Christina Jern
Christian Blomstrand
Gunilla Forsberg-Wärleby
Lars-Åke Levin
Publication date: 01-11-2017
Publisher: Springer International Publishing
Published in: Quality of Life Research / Issue 11/2017
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI: https://doi.org/10.1007/s11136-017-1636-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Long-term QALY-weights among spouses of dependent and independent midlife stroke survivors

Abstract

Purpose

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2017

Longitudinal validity and reliability of the Myeloma Patient Outcome Scale (MyPOS) was established using traditional, generalizability and Rasch psychometric methods

Children’s family experiences: development of the PROMIS® pediatric family relationships measures

Health-related quality of life in paediatric patients with congenital heart defects: association with the type of heart defect and the surgical technique

Use-of-time and health-related quality of life in 10- to 13-year-old children: not all screen time or physical activity minutes are the same

Establishing benchmark EQ-5D-3L population health state utilities and identifying their correlates in Gansu Province, China

The quality of life of older people aging in place: a literature review