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European Journal of Heart Failure 2008 10(10):1033-1039; doi:10.1016/j.ejheart.2008.07.015
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© 2008 European Society of Cardiology

Quality-adjusted life year weights among elderly patients with heart failure

Urban Alehagena,*, Mikael Rahmqvistb, Thomas Paulssonc and Lars-Åke Levinb

a Department of Cardiology, Heart Centre, University Hospital of Linköping SE-581 85 Linköping, Sweden
b Center for Medical Technology Assessment, University of Linköping SE-581 83 Linköping, Sweden
c Department of Health Economics AstraZeneca Sverige AB, SE-151 85 Södertölje, Sweden

* Corresponding author. Tel.: +46 13 22 20 00. E-mail address: Urban.Alehagen{at}IHS.liu.se (U. Alehagen).


  Abstract

Background: When assessing health-related quality of life (HRQoL) in elderly patients with heart failure (HF), the process of obtaining quality-adjusted life year (QALY) weights is generally complicated and time-consuming.

Aim: To evaluate whether information regarding HRQoL and QALY weights can be derived directly from the established and widely used New York Heart Association (NYHA) functional classification system.

Methods: NYHA functional status was assessed independently both by the individual patients and by the examining cardiologist in 323 elderly patients with symptoms of HF recruited from primary care. HRQoL was evaluated using the SF-36 questionnaire and a time trade-off (TTO) scenario. The TTO technique generates direct QALY weights.

Results: Both the TTO technique and SF-36 values demonstrated a statistically significant correlation with NYHA functional status. The TTO values also correlated with all SF-36 dimensions. Increasing impairment was associated with statistically significant drops in both SF-36 values and TTO-based QALY weights. For patients in NYHA classes I–IV the QALY weights were 0.77, 0.68, 0.61, and 0.50, respectively. Thus in elderly patients, symptoms of HF have a major impact on perceived quality of life.

Conclusion: The results of the present study show that QALY weights, an important instrument in the health economic evaluation of treatment strategies, can be derived directly from NYHA classification in elderly HF patients.

Key Words: Heart failure • Elderly patients • Health related quality of life • QALY

Received January 16, 2008; Revised May 22, 2008; Accepted July 24, 2008


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