Health Services Research Group, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain.
PLoS One. 2013;8(3):e60477. doi: 10.1371/journal.pone.0060477. Epub 2013 Mar 28.
We aimed to assess the changes in health-related quality of life (HRQL) in patients with confirmed diagnosis of influenza (H1N1)2009, and to estimate the individual and societal loss of quality-adjusted life years (QALYs) caused by the pandemic.
Longitudinal study of patients recruited at major hospitals and primary care centers in Spain. Patients reported their HRQL (EQ-5D) during their influenza episode and seven days prior to it. A subsample was monitored to evaluate HRQL after recovery. HRQL loss was estimated as the difference between EQ-5D prior to the influenza episode and during it. Individual QALY loss (disutility multiplied by the duration of the influenza episode in days) for confirmed cases was calculated and used to estimate the societal loss in Spain (with the official estimations). A total of 432 inpatients and 563 outpatients were included, of whom 145 and 184, respectively, were followed up. Baseline mean HRQL loss was 0.58 (95% CI, 0.53-0.63) for inpatients and 0.43 (95% CI, 0.40-0.46) for outpatients. The majority of the 145 inpatients and 184 outpatients who were followed up regained initial HRQL levels, presenting a mean difference of 0.01 between the EQ-5D score prior to and after the influenza episode. Individual QALY losses for inpatients (0.031, 95% CI, 0.025-0.037) were higher than for outpatients (0.009, 95% CI, 0.007-0.011), while societal QALY losses were reversed: 94 years for inpatients and 6,778 years for outpatients. For fatal cases (an official number of 318), we estimated a QALY loss of 11,981.
The influenza (H1N1)2009 pandemic had a significant but temporary impact on the HRQL of the majority of confirmed in- and outpatients. The societal impact of the influenza pandemic in Spain was estimated to be higher than other acute conditions. These results provide useful data for future cost-utility analyses.
本研究旨在评估确诊感染 2009 年甲型 H1N1 流感（以下简称“甲流”）患者的健康相关生命质量（HRQL）变化，并估算此次流感大流行造成的个体生命质量调整年（QALY）损失和社会生命质量调整年损失。
这是一项在西班牙多家主要医院和基层医疗机构招募患者的纵向研究。患者在感染流感期间及感染前 7 天报告 HRQL（EQ-5D）情况。对部分患者进行了随访，以评估其康复后的 HRQL。HRQL 损失定义为流感发作前的 EQ-5D 评分与流感发作期间的评分差值。对确诊病例的个体 QALY 损失（失能程度乘以感染流感的天数）进行了估算，并用于估算西班牙的社会生命质量调整年损失（采用官方估计值）。共纳入 432 例住院患者和 563 例门诊患者，其中分别有 145 例和 184 例患者完成了随访。住院患者和门诊患者的基线 HRQL 损失平均值分别为 0.58（95%CI：0.530.63）和 0.43（95%CI：0.400.46）。145 例完成随访的住院患者和 184 例完成随访的门诊患者中有多数人恢复到初始 HRQL 水平，流感发作前后 EQ-5D 评分差值的平均值为 0.01。住院患者的个体 QALY 损失（0.031，95%CI：0.0250.037）高于门诊患者（0.009，95%CI：0.0070.011），而社会生命质量调整年损失则相反：住院患者为 94 年，门诊患者为 6778 年。对于死亡病例（官方报告为 318 例），我们估算其 QALY 损失为 11981。
甲流大流行对大多数确诊住院和门诊患者的 HRQL 产生了显著但暂时的影响。西班牙流感大流行对社会生命质量的影响估计高于其他急性疾病。这些结果为未来的成本效用分析提供了有用的数据。
