Assessment of Retrospective Collection of EQ-5D-5L in US Patients with COVID-19 (preprint)

ABSTRACT

Background: The impact of COVID-19 goes beyond the acute phase of infection. It is imperative to evaluate health related quality of life (HRQoL) pre-COVID-19 , but there is currently no evidence of the retrospective application of the EQ-5D-5L for COVID-19 studies. Methods: Subjects with at least 1 self-reported symptom and positive RT-PCR for SARS-CoV-2 at CVS Health US test sites were recruited between 01/31/2022-04/30/2022. On the day of enrollment which was around day 3 after testing positive, consented participants completed the EuroQol 5D-5L (EQ-5D-5L) questionnaire twice a modified version where all the questions were past tense to retrospectively assess pre-COVID-19 baseline QoL, and the standard version in present tense to assess current HRQoL. Duncan's new multiple range test was adopted for post analysis of variance pairwise comparisons of EQ-VAS means between problem levels for each of 5 domains. A linear mixed model was applied to check whether the relationship between EQ visual analog scale (VAS) and utility index (UI) was consistent pre-COVID-19 and during COVID-19. Matching-adjusted indirect comparison was used to compare pre-COVID-19 UI and VAS scores with those of the US population. Cohen's d was used to quantify the magnitude of difference in means between two groups. Results: Of 676 participants, 10.2% were age 65 or more years old, 73.2% female and 71.9% white. Diabetes was reported by 4.7% participants and hypertension by 11.2%. The pre-COVID-19 baseline mean UI was 0.924 and the mean VAS was 87.4. The estimated coefficient for the interaction of UI-by-retrospective collection indicator (0=standard prospective collection for Day 3 after COVID-19 testing, 1=retrospective for pre-COVID-19), -4.2 (SE 3.2), P=0.197, indicates that retrospective collection does not significantly alter the relationship between EQ-VAS and UI. After adjusting for age, gender, diabetes, hypertension, and percent of mobility problems, predicted means of pre-COVID-19 baseline VAS and UI were 84.6 and 0.866, respectively. Both of these means were close to published US population norms (80.4 and 0.851) than those observed (87.4 and 0.924). After adjusting for age, gender, diabetes, and hypertension, 19.0% patients with COVID-19 had mobility problems, which was significantly lower than US population norm 25.2%, P<0.001. The calculated ES for UI and VAS were 0.15 and 0.39, respectively. Conclusion: At a group level the retrospectively collected pre-COVID-19 EQ-5D-5L is adequate and makes it possible to directly evaluate the impact of COVID-19 on HRQoL. Future studies are encouraged that are tailored to directly compare standard prospective assessment with retrospective assessment on the EQ-5D-5L during pre-COVID-19.