Abstract TMP76: Direct Assessment of Health Utilities Among Patients With Intracerebral Hemorrhage Using the Standard Gamble Method

Introduction: EuroQoL-5 Dimension (EQ-5D) is a validated albeit indirect method to derive health utilities (HU). Conversely, Standard Gamble (SG) directly measures patients’ valuation of their health state. We compare in-hospital and day-90 SG Utilities (SGU) among intracerebral hemorrhage (ICH) patients and report a three-way association between SGU, EQ-5D and mRS at day-90. Methods: Primary ICH patients were enrolled in a multisite cohort and underwent in-hospital and day-90 assessments for the mRS, EQ-5D, and SG. SG entails providing patients a choice between their current health state and a hypothetical treatment (a pill) with varying chances of either perfect health or a painless death. Higher SGU (scale 0 - 1) indicates a lower risk-tolerance for death; thus, a higher valuation of one’s health state. Median and interquartile range (IQR) are reported. Logistic regression was used to estimate the likelihood of low SGU (≤ 0.6) and Wilcoxson paired signed rank test compared in-hospital and day-90 SGU. Results: In-hospital and day-90 SG was obtained from 381 and 280 patients respectively (including 236 paired observations). Median (IQR) in-hospital and day-90SGU were 0.85 (0.40-0.98) and 0.98 (0.75-1.00) (p < 0.001). In-hospital SGU were lower with advancing age (p = 0.007), with higher NIHSS and ICH scores (p < 0.001), and with greater treatment intensity. Proxies evaluated lower SGU (p < 0.001). In the adjustedmodel, higher NIHSS and proxy assessments were independently associated with lower SGU, along with an interaction between age and SGU by race (white vs. black) (Figure). Day-90 SGU and mRS were correlated (p < 0.001), however SGU were increasinglyhigher than the EQ-5D HU at higher mRS scores (Figure). Conclusion: Divergence between directly and in-directly assessed HU at high levels of functional disability warrant careful prognostication of ICH outcomes, and should be considered in designing early end-of-life care discussions with families and patients.