Preference-based quality of life in patients with cerebral aneurysms

Background and Purpose - Functional outcome scales are typically used to measure quality of life (QOL) and outcomes in patients with cerebral aneurysms; however, these instruments only examine a limited number of domains that contribute to QOL. An alternative are preference-based QOL methods, which integrate all factors contributing to QOL and provide a comprehensive individualized measure of how patients value their current health state. An additional advantage of preference-based QOL values is that they can be incorporated into decision analyses and cost-effectiveness analyses. Methods - We used 4 preference-based QOL methods to measure QOL in 176 outpatients with cerebral aneurysms: (1) standard gamble; (2) time trade-off; (3) visual analogue scale; and (4) willingness to pay. We measured functional status with the Glasgow Outcome Scale (GOS), Rankin Scale, and Barthel Index. We then built multivariate linear regression models to examine the relationships between preference-based QOL, functional status, and patient characteristics. Results - Preference-based QOL was moderately diminished in the aneurysm patients. Mean values were; standard gamble, 0.78; time trade-off, 0.79; visual analogue scale, 0.67; and willingness to pay, $121 000. Preference-based QOL was not well-explained by functional status or patient characteristics, as shown by regression models that accounted for <15% of the variation in preference-based QOL (R²<0.15). Conclusions - Preference-based QOL instruments capture components of QOL in patients with cerebral aneurysms not assessed by functional status measures or patient characteristics. Studies of patients with cerebral aneurysms should consider incorporating preference-based QOL measures for a fuller evaluation of the impact of aneurysmal disease and its treatment on QOL.