Health-related quality of life after stroke: review of the literature and implications for future research.

Limits on health care resources mandate that resource-allocation decisions be guided by consideration of cost in relation to the associated expected benefits. It therefore leads to an increased demand for economic evaluation and medical technology assessment. Nowadays, cost-effectiveness analysis (CEA) has emerged as a favored analytic technique for economic evaluation in health care. Currently the leading standard in Western countries is the use of health-adjusted life years (HAYLs) in CEA of medical care and health interventions, as well as in estimating burden of disease. Being an umbrella term of a family of measures, HALYs include quality-adjusted life years (QALYs) and disability-adjusted life years (DALYs). In this review we give a concise overview on QALYs and DALYs, and examine variations in QALYs and DALYs estimates currently used in stroke studies. Given the lack of reliable and valid measurement methods in eliciting utility values in QALYs or disability values in DALYs, CEA needs to be addressed in a clear and transparent way to ensure its proper use in practice.