The Health Utility of Age-Related Oropharyngeal Dysphagia

Introduction: Oropharyngeal dysphagia is prevalent among the elderly and heightens the risk of aspiration pneumonia, malnutrition, and psychosocial impairment. Health utility values (HUV) quantify the severity of a disease state. This study aims to measure the health utility of age-related oropharyngeal dysphagia.

Methods: Adults were recruited to assess four health states (mild dysphagia, severe dysphagia, monocular blindness, binocular blindness) through a computer-based survey where each health state was represented by a vignette describing the associated functional capabilities and limitations. The survey employed the direct utility elicitation survey methods of visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO). HUVs were compared using one-way analysis of variance and post hoc analysis.

Results: Forty-two participants (57.1% female, median age 35 years) completed the survey. No significant difference was found between the health utility of mild dysphagia (VAS = 0.84, SG = 0.93, TTO = 0.89) and monocular blindness (VAS = 0.77, SG = 0.87, TTO = 0.83) across VAS (95% CI: -0.06-0.20, p=0.50), SG (95% CI: -0.06-0.18, p=0.56), and TTO (95% CI: -0.05-0.17, p=0.53). Severe dysphagia (VAS = 0.41, SG = 0.68, TTO = 0.64) was valued as equivalent to binocular blindness (VAS = 0.41, SG = 0.67, TTO = 0.60) across VAS (95% CI: -0.13-0.13, p=0.99), SG (95% CI: -0.11-0.14, p=0.99), and TTO (95% CI: -0.07-0.16, p=0.75). Both mild dysphagia and monocular blindness were valued as favorable to severe dysphagia and binocular blindness.

Conclusions: The health utility of mild dysphagia was comparable to monocular blindness, and the health utility of severe dysphagia was comparable to binocular blindness. These findings suggest that age-related oropharyngeal dysphagia has dramatic impacts on perceived quality-of-life. These findings also highlight the critical need for developing new treatments for this condition.