Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Measuring Health Impacts of Post-stroke Aphasia Treatments: Does the EQ-5D-3L Measure-up? (106819)

Sally Zingelman 1 2 3 , Sarah J Wallace 1 2 3 , Joosup Kim 4 5 , Sam Harvey 1 2 3 , Miranda L Rose 3 6 , John E Pierce 3 6 , Kathleen L Bagot 4 5 , Dominique A Cadilhac 3 4 5
  1. Queensland Aphasia Research Centre, the University of Queensland., Herston, QUEENSLAND, Australia
  2. Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, the University of Queensland and Metro North Health, Herston, Queensland, Australia
  3. Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melborne, Victoria, Australia
  4. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
  5. Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  6. School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia

Introduction: Quality Adjusted Life Years, derived from utility values, are vital in quantifying the health impacts of treatments for economic evaluations. The Stroke and Aphasia Quality of Life Scale-39g (SAQOL-39g) is validated for people with aphasia and widely used in research. However, scores cannot produce utility values. The study aimed to determine potential future directions for economic evaluations of aphasia treatments by comparing SAQOL-39g scores with scores from a generic quality-of-life instrument commonly used for estimating utility values.

Methods: Pooled survey data from the Constraint Induced or Multi-Modal Personalised Aphasia Rehabilitation (COMPARE) randomised control trial. Quality of life was rated by participants at baseline and 12-week outcome assessment using the SAQOL-39g and the generic Euroqol 5-Dimensions Health Questionnaire, 3-Level (EQ-5D-3L). Spearman’s rank correlation coefficient (r) was used to describe correlations between the EQ-5D-3L (domain and utility scores; visual analogue scale) and the SAQOL-39g (domain and total mean scores).

Results: 201 participants completed both surveys (69% male, median age 63.6 years, median time since stroke 2.5 years). 45-79% of participants rated themselves at full health across the EQ-5D-3L dimensions, compared to 0-6% on the SAQOL-39g at baseline. Ceiling effects on the EQ-5D-3L limited responsiveness to change. Convergent validity between the SAQOL-39g communication domain and the EQ-5D-3L (r 0.15-0.26) was weak.

Conclusion: In people with chronic aphasia the EQ-5D-3L was not sensitive to detecting change and is likely to produce inaccurate utility values.

Relevance to clinical practice: With approximately a third of patients with stroke experiencing aphasia, the EQ-5D-3L instrument may underestimate the overall burden of stroke. These results raise implications for economic evaluations comparing stroke outcomes with other health conditions. Development of utility valuation for quality-of-life instruments for people with aphasia is needed to ensure the value of new treatments can be prioritised in clinical care.