Persson Josefine, Levin Lars-Åke, Holmegaard Lukas, Redfors Petra, Jood Katarina, Jern Christina, Blomstrand Christian, Forsberg-Wärleby Gunilla
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
Health Metrics, the Sahlgrenska Academy at University of Gothenburg & Centre for Health Economics (CHEGU), University of Gothenburg, Box 414, 405 30, Gothenburg, Sweden.
Health Qual Life Outcomes. 2017 Jul 25;15(1):150. doi: 10.1186/s12955-017-0724-7.
Healthcare interventions that have positive effects on the stroke survivors' health-related quality of life (HRQoL) and quality-adjusted life-years (QALYs) might also have positive effects for their spouses in terms of improved HRQoL and/or reduced spousal informal support. However, knowledge about stroke survivors' HRQoL and QALY and the consequences for their spouses' HRQoL and QALY is limited. Therefore, the aim of this study was to describe the HRQoL and QALY-weights in dyads of stroke survivors in comparison with dyads of healthy controls, and to study the relationship between the stroke survivors' QALY-weights and consequences for spouses in terms of QALY-weight and annual cost of informal support, using a long-term perspective.
Data on stroke survivors, controls, and spouses were collected from the seven-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). HRQoL was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. The magnitude of the support was assessed with a study specific time-diary. An ordinary least squares (OLS) regression was used to estimate the association between stroke survivors' and spouses' QALY-weights. A two-part econometric model was used to estimate the association between stroke survivors' QALY-weights and the time spent and cost of spouses' informal support.
Cohabitant dyads of 248 stroke survivors' aged <70 at stroke onset and 245 controls were included in the study. Stroke survivors had lower HRQoL in the SF-36 domains physical functioning, physical role, general health, vitality (P < 0.001), and social functioning (P = 0.005) in comparison with their cohabitant spouses. There was no significant difference in HRQoL for the dyads of controls. The results from the regression analyses showed that lower QALY-weights of the stroke survivors were associated with lower QALY-weights of their spouses and increased annual cost of spousal informal support.
Our results show that the QALY-weights for stroke survivors had consequences for their spouses in terms of annual cost of spousal informal support and QALY-weights. Hence, economic evaluation of interventions that improve the HRQoL of the stroke survivors but ignore the consequences for their spouses may underestimate the value of the intervention.
对中风幸存者的健康相关生活质量（HRQoL）和质量调整生命年（QALYs）有积极影响的医疗保健干预措施，在改善配偶的HRQoL和/或减少配偶的非正式支持方面，可能也有积极影响。然而，关于中风幸存者的HRQoL和QALY以及对其配偶的HRQoL和QALY的影响的知识是有限的。因此，本研究的目的是描述中风幸存者二元组与健康对照二元组相比的HRQoL和QALY权重，并从长期角度研究中风幸存者的QALY权重与配偶在QALY权重和非正式支持年度成本方面的影响之间的关系。
从哥德堡大学医学院缺血性中风研究（SAHLSIS）的七年随访中收集中风幸存者、对照者和配偶的数据。HRQoL通过SF-36进行评估，基于偏好的健康状态值通过SF-6D进行评估。支持程度通过一项特定研究的时间日记进行评估。使用普通最小二乘法（OLS）回归来估计中风幸存者和配偶的QALY权重之间的关联。使用两部分计量经济模型来估计中风幸存者的QALY权重与配偶非正式支持的时间和成本之间的关联。
本研究纳入了248名中风发作时年龄<70岁的中风幸存者的同居二元组和245名对照者。与同居配偶相比，中风幸存者在SF-36的身体功能、身体角色、总体健康、活力（P<0.001）和社会功能（P = 0.005）领域的HRQoL较低。对照二元组的HRQoL没有显著差异。回归分析结果表明，中风幸存者较低的QALY权重与其配偶较低的QALY权重以及配偶非正式支持年度成本的增加有关。
我们的结果表明，中风幸存者的QALY权重在配偶非正式支持年度成本和QALY权重方面对其配偶有影响。因此，对改善中风幸存者HRQoL但忽略对其配偶影响的干预措施进行经济评估，可能会低估干预措施的价值。
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