Abstract TP267: Uncertainty-Based Individual Health Preferences for Patients With Primary Intracerebral Hemorrhage

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Abstract

Introduction: Value-based care and patient-perceived outcomes are increasingly important. Standard Gamble (SG) derived utilities directly measure patients’ preferences for health states and form the basis of health economic analyses. We describe distribution of and factors associated with SG utilities (SGU) in a cohort of intracerebral hemorrhage (ICH) patients, and explore changes in SGU over 90 days post-discharge.

Methods: Our study is a multisite cohort aiming to evaluate the comparative effectiveness of ICH patient management at various levels of care across Texas. Consented patients undergo assessments including SG in-hospital, and 30 and 90 days post-discharge. The SG assesses patients’ risk-taking behavior toward achieving a perfect health status, and outputs utility on a scale of 0 - 1 (Figure 1). Median and interquartile range (IQR) are reported for inpatient and day-90 SGU. Quantile regression was used to evaluate factors associated with SGU. Difference in median (DIM) and 95% confidence interval (CI) for the difference are reported.

Results: 158 patients have been enrolled. Inpatient and day-90 SG was obtained from 132 and 54 patients respectively. Median inpatient SGU are significantly lower for older patients, white patients (compared to black patients), and those with higher ICH scores (Table 1). Median day-90 SGU was higher than inpatient SGU (DIM: 0.27; 95% CI: 0.08-0.46). Age >65 and higher ICH score were independently associated with lower SGU (Age: DIM -0.30; 95% CI -0.49, -0.11) (ICH Score: DIM -0.59; 95% CI -0.97, -0.21). Patients with mRS scores 0-3 at day 90 had higher SGU values compared to those with mRS scores 4-5 (DIM: 0.25, 95% CI: 0.09 - 0.41). Enrollment continues; updated analyses to be presented.

Conclusion: Direct assessment of preferences for a morbid condition like ICH provides unique insight into patient values. Assessment of SGU may be routinely conducted in ICH patient studies to generate evidence for comparative effectiveness.

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