gms | German Medical Science

Objective: Quality of life years (QALY) are nowadays commonly used to estimate the efficiency and benefits of the chosen treatment. Despite its universal presence in health-economical papers, the utilities used to assess QALYs often lack evidence and are mostly extrapolated by other neurological disorders such as stroke patients from the global burden of diseases study. Our aim was to determine health-specific utilities in neurosurgical patients with intracranial tumors pre- and postoperatively, in order to examine its behavior among patients over time (intraindividual) and between patients themselves (interindividual).

Methods: We prospectively enrolled patients diagnosed with intracranial lesions before surgical treatment and measured specific health preferences and utilities based on the cardinal scale ranging from 0 (equal to the worst health state) to 1 (healthy) using the time trade off (TTO) and standard gambling (SG) method regarding the actual health state and the theoretical scenario of severe neurological symptoms such as hemiplegia, aphasia and permanent dependency for a time period of 10 years. In addition to the specific health preferences, we used the EQ-5D survey and the Becks Depression Index (BDI) and correlated the data with the neurological status as well as the postoperative diagnosis.

Results: In total, we obtained complete data on 28 patients with intracranial eloquent lesions. 40% suffered from WHO IV glioblastoma, 33% had intracranial metastases and 25% had been treated for low grade glioma. Pre- and postoperative utilities ranged from u=0 to 1 measured by the TTO and SG method for the actual health state, the hypothetical case of hemiplegia, aphasia, long-term dependency and risk of such during surgery. Utilities measured differed significantly over time (u=0.825 vs. 0.69, p< 0.05 and u=0.668 vs. 0.54 p <0.05 for the actual health state and hemiplegia correspondingly). There was a trend towards a more tolerant perception for the operative risks of neurological deficits postoperatively (cut-off to indifference 31% vs. 42%), although the differences in perceived utilities did not reach statistical significance.

Conclusion: Patients perception of their current health status (utility) varies not only between patients but also in patients themselves using the TTO and SG method. Utilities can be derived for different hypothetical scenarios individually and increase our understanding of health specific quality of life in patients with intracranial lesions.