OBJECTIVES: The modified Rankin Scale (mRS) is frequently used in clinical studies to measure the level of disability following stroke and TIA. As the mRS is a disease-specific instrument, it can not be easily translated into preference-based utility-weights to be used in cost-effectiveness analyses (CEAs). Data on utility-weights by the mRS disability level are limited. We estimated the relation between mRS scores and utility-weights in a convenience sample of "real-world" stroke survivors. METHODS: During a personal interview of 148 community dwelling long-term stroke survivors attending day-care rehabilitation centers throughout Israel, we estimated the level of disability using the mRS, ranging from: no symptoms/disability (mRS=0), to severe disability (mRS=5). Patients also completed the EuroQoL (EQ-5D) questionnaire, the most commonly used instrument for obtaining utility values. Utility-weights were calculated using the EQ-5D UK tariffs. Health states may range from -0.594 to 1, where 1.0 is defined as perfect health and zero represents death. RESULTS: Mean age (±SD) of patients was 65.8±9.8, ranging from 28-85 years, with male predominance of 73.6%. Over 80% of patients were married, living with their spouse or family. The vast majority (92%) of patients did not work at the time of interview, mainly due to the stroke. Mean time from first stroke was 7.2±5.9 years and 1/3 of respondents experienced >1 stroke events. Mean utility-weights (±SD) were as follows: mRS 0-1(N=31), 0.748±0.231; mRS 2-3 (N=78), 0.395±0.317; mRS 4-5 (N=38), 0.055±0.277. 19% of patients had a utility-weight <0 representing a health state considered worse than death.        CONCLUSIONS: While utility-weights of stroke survivors with no symptoms/no significant disability (mRS 0-1), are comparable to those used in published CEAs, patients with moderate and severe disability (mRS 4-5) show an extremely low quality of life. These findings should be considered in future planning of interventions in stroke patients.