Abstract TMP73: Direct Valuation Of Long-Term Health State By Survivors Of Severe Intracerebral And Intraventricular Hemorrhage Using Time Trade-off Utility

Objective: To describe direct valuation of long-term health state by survivors of severe intracerebral and intraventricular hemorrhage (ICH/IVH) using time-trade off utility (TTO-U). TTO-U requires patients to choose between trading off years of their life in exchange for a hypothetical treatment that returns them to full functionality. Higher TTO-U (0-1) indicates lower desire to trade time off and thus a higher valuation of current health state. Methods: CLEAR III and MISTIE III trial survivors who recorded TTO-U at 180-days post-ictus were included. TTO-U was dichotomized into ≤0.6 versus >0.6. Multivariable logistic regression assessed factors associated with TTO-U≤0.6, including clinical variables, quality of life and depression scales. Results: Among 774 CLEAR III and MISTIE III survivors at day-180, 442 (57%) reported TTO-U; 305 (69%) were self-reported, 122 (28%) by a proxy. Mean (SD) age was 58.4 (11.8) years, 41% female, 25% black, 68% white and 7% other races. Mean (SD) ICH volume was 33.5 (22.8) mL, IVH volume 9.1 (14.8) mL, 70% had deep ICH. Median (IQR) 180-day mRS was 3 (3-4) and TTO-U was 1.0 (0.7-1). TTO-U of 1.0 was reported by 269 (61%) and ≤0.6 by 110 (25%) patients. Increasing age, white race, but not sex, were associated with lower TTO-U. Proxy-based TTO-U scores were lower (mean, 0.76 vs. 0.83, p=0.03). In multivariable logistic regression, age (aOR per 10-yrs, 1.24 [1.003-1.52]), race (white vs. other races, 4.8 [1.1-21.3]), proxy-based assessment (1.81 [1.02-3.21]), new ischemic stroke (2.01 [1.1-3.7]), sepsis (6.6 [1.1-40.3]), gastrostomy (0.40 [0.21-0.77]) were associated with TTO-U≤0.6 after adjusting for ICH severity. Among EuroQol 5-dimensions, difficulty with selfcare (3.3 [1.97-5.62]), and anxiety/depression (1.72 [1.07-2.74]) were independently associated with TTO-U≤0.6. CES-Depression score (in MISTIE III only) was also associated with TTO-U≤0.6 (per 1-point, 1.05 [1.02-1.07]). Conclusion: Majority of survivors of severe ICH/IVH highly valued their long-term health state and were unwilling to trade time off despite significant disability. Race, age, hospital complications, inability to care for self and anxiety/depression at day-180 were associated with lower valuation of long-term health state.