Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, Hobart, 7000, Australia.
Tasmanian School of Business and Economics, University of Tasmania, Churchill Avenue, Sandy Bay, 7005, Australia.
Qual Life Res. 2024 Jun;33(6):1675-1689. doi: 10.1007/s11136-024-03620-4. Epub 2024 Apr 5.
People living with multiple sclerosis (PwMS) in metropolitan Victoria, Australia, experienced a 112-day, COVID-19-related lockdown in mid-2020. Contemporaneously, Australian PwMS elsewhere experienced minimal restrictions, resulting in a natural experiment. This study investigated the relationships between lockdowns, COVID-19-related adversity, and health-related quality of life (HRQoL). It also generated health state utilities (HSU) representative of changes in HRQoL.
Data were extracted from Australian MS Longitudinal Study surveys, which included the Assessment of Quality of Life-Eight Dimensions (AQoL-8D) instrument and a COVID-19 questionnaire. This COVID-19 questionnaire required participants to rank their COVID-19-related adversity across seven health dimensions. Ordered probits were used to identify variables contributing to adversity. Linear and logit regressions were applied to determine the impact of adversity on HRQoL, defined using AQoL-8D HSUs. Qualitative data were examined thematically.
N = 1666 PwMS (average age 58.5; 79.8% female; consistent with the clinical presentation of MS) entered the study, with n = 367 (22.0%) exposed to the 112-day lockdown. Lockdown exposure and disability severity were strongly associated with higher adversity rankings (p < 0.01). Higher adversity rankings were associated with lower HSUs. Participants reporting major adversity, across measured health dimensions, had a mean HSU 0.161 (p < 0.01) lower than participants reporting no adversity and were more likely (OR: 2.716, p < 0.01) to report a clinically significant HSU reduction. Themes in qualitative data supported quantitative findings.
We found that COVID-19-related adversity reduced the HRQoL of PwMS. Our HSU estimates can be used in health economic models to evaluate lockdown cost-effectiveness for people with complex and chronic (mainly neurological) diseases.
澳大利亚维多利亚州大都市的多发性硬化症（MS）患者在 2020 年中期经历了为期 112 天的与 COVID-19 相关的封锁。与此同时，澳大利亚其他地方的 MS 患者经历了最小的限制，这导致了一个自然实验。本研究调查了封锁、与 COVID-19 相关的逆境和健康相关生活质量（HRQoL）之间的关系。它还生成了代表 HRQoL 变化的健康状态效用（HSU）。
数据从澳大利亚多发性硬化症纵向研究调查中提取，其中包括生活质量评估-八个维度（AQoL-8D）工具和 COVID-19 问卷。该 COVID-19 问卷要求参与者对七个健康维度的 COVID-19 相关逆境进行排名。有序概率用于确定导致逆境的变量。线性和对数回归用于确定逆境对 HRQoL 的影响，使用 AQoL-8D HSU 定义。对定性数据进行主题分析。
1666 名多发性硬化症患者（平均年龄 58.5 岁；79.8%为女性；与多发性硬化症的临床表现一致）参与了该研究，其中 367 名（22.0%）患者暴露于 112 天的封锁中。暴露于封锁和残疾严重程度与更高的逆境排名密切相关（p<0.01）。更高的逆境排名与更低的 HSU 相关。报告在所有测量的健康维度上存在重大逆境的参与者的平均 HSU 比报告没有逆境的参与者低 0.161（p<0.01），并且更有可能（OR：2.716，p<0.01）报告具有临床意义的 HSU 降低。定性数据中的主题支持定量发现。
我们发现，与 COVID-19 相关的逆境降低了多发性硬化症患者的 HRQoL。我们的 HSU 估计可用于健康经济模型，以评估对患有复杂和慢性（主要是神经）疾病的人群进行封锁的成本效益。
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