Quantifying the Value of Stroke Disability Outcomes: WHO Global Burden of Disease Project Disability Weights for Each Level of the Modified Rankin Scale
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Background and Purpose— The modified Rankin Scale (mRS) categorizes poststroke disability among 7 broad, ordinal grades, but the interval distances between these levels are spaced along the disability spectrum have not been previously investigated. Methods— We used the person trade-off procedure developed by the World Health Organization Global Burden of Disease Project (WHO-GBDP) to generate disability weights (DWs) ranging from 0 (normal) to 1 (dead) for each of 7 mRS grades. The ratings of an international, 9-member panel of stroke experts were combined by a modified Delphi process. Results— DWs (95% CI) were 0 for mRS 0, 0.046 (0.004 to 0.088) for mRS 1, 0.212 (0.175 to 0.250) for mRS 2, 0.331 (0.292 to 0.371) for mRS 3, 0.652 (0.625 to 0.678) for mRS 4, 0.944 (0.873 to 1.015) for mRS 5, and 1.0 for mRS 6. DWs of adjacent mRS levels were significantly different ( P <0.001 for all). Coefficients of variation showed a high degree of consensus for DWs among panel members. DWs placed each of the 5 intermediate mRS states in different disability class levels of the WHO-GBDP anchor conditions and identified natural clusters to use when reducing the mRS to fewer categories. Conclusions— Formal DW assignment confirms that the mRS is an ordered but unequally spaced scale. The availability of DWs for each mRS level now permits direct comparison of each poststroke outcome state with the outcomes of hundreds of other diseases in the WHO-GBDP and the expression of stroke burden in different populations by using the uniform metric of disability-adjusted life-years lost.
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The Global Burden of Disease disability weight approach allows calculation of disability-adjusted life-years gained per health dollar expended.
“This approach allows calculation of disability-adjusted life-years gained per health dollar expended.”
From Statistical Analysis of the Primary Outcome in Acute Stroke Trials (2012) · cites this paper as [58]
The Introduction says the disability-weight approach permits analysis of treatment and policy outcomes in DALYs gained or lost. Neither that passage nor the relevant Methods and Discussion passages says it calculates DALYs gained per health dollar expended; the cost denominator is unsupported. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe absolute health value of each of the levels of the mRS has been derived using the World Health Organization's Global Burden of Disease project disability weight system.
“The absolute health value of each of the levels of the mRS has been derived using World Health Organization's Global Burden of Disease project disability weight system.”
From Statistical Analysis of the Primary Outcome in Acute Stroke Trials (2012) · cites this paper as [58]
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Salomon, J. A., Vos, T., Hogan, D. R., Gagnon, M., Naghavi, M., Mokdad, A., Begum, N., Shah, R., Karyana, M., Kosen, S., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61680-8 · Cited by 1,322 · see citing works
Statistical Analysis of the Primary Outcome in Acute Stroke Trials
Bath, P. M. W., Lees, K. R., Schellinger, P. D., Altman, H., Bland, M., Hogg, C., Howard, G., & Saver, J. L. (2012) · Stroke · doi:10.1161/strokeaha.111.641456 · Cited by 266 · see citing works
Self-citationReview of disability weight studies: comparison of methodological choices and values
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- Authors
- Hong, K.-S., & Saver, J. L.
- Affiliations
- Inje University (KR)
- Venue
- Stroke
- Published
- 2009-12
- Volume
- 40
- Issue
- 12
- Pages
- 3828-3833
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- PMC
- PMC2788070
- OpenAlex
- W1861115201
- Cited by
- 213
- References
- 1
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 13 · 2023: 8 · 2022: 11 · 2021: 17 · 2020: 18 · 2019: 20 · 2018: 10 · 2017: 22 · 2016: 17 · 2015: 12 · 2014: 12 · 2013: 8 · 2012: 8
- FWCI
- 14.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Ministry of Health and Welfare
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke (NS044378, P50NS044378)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- modified Rankin Scale, stroke disability, disability weights, person trade-off, disability-adjusted life years, stroke burden, expert consensus, Delphi method
- MeSH terms
- Stroke Rehabilitation, Activities of Daily Living, Data Interpretation, Statistical, Disability Evaluation, Persons with Disabilities, Humans, Length of Stay, Patient Care Team, Prognosis, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Global Health, World Health Organization, Observer Variation, Outcome Assessment, Health Care, Cost of Illness, Stroke
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