I read with great interest the recent article by Pinckaers et al1 published in Value in Health, I read with great interest the recent article by Pinckaers et al1 published in Value in Health. This study is an excellent contribution to the field of health economics, addressing one of the most pressing unmet needs: the estimation of costs and health utility values per modified Rankin Scale (mRS) score, which are essential for health economic evaluations related to stroke. Although the research directly contributes to the context of health economic evaluations in the Netherlands, the robustness of its cost and health utility estimates will also significantly contribute to subsequent evidence. Although the study is valuable, I would like to point out 2 potential biases that are not mentioned in the article.