The effect of measles on health-related quality of life: a patient-based survey

Abstract

Background: Measles is a highly contagious and potentially fatal illness preventable through vaccination. Outbreaks in the UK and many other European countries have been increasing over recent years, with over 3,207 laboratory-confirmed cases reported by Public Health England from January 2012 to the end of June 2013. To aid rational decision making regarding measles control versus other use of healthcare resources, it is important to measure the severity of measles in units that are comparable to other diseases. The standard metric for this in the UK is the quality-adjust life year (QALY). To our knowledge, the impact of measles on health-related quality of life (HRQoL) in terms of QALYs has not been quantified.

Methods and findings: Individuals with confirmed measles were sent questionnaires requesting information on the short-term impact of the illness on their HRQoL using the EuroQol EQ-5D-3L questionnaire. HRQoL was reported for the day the questionnaire was received, the worst day of infection and at follow-up three weeks later. 507 questionnaires were sent to individuals with confirmed measles with 203 returned (40%). The majority of respondents were not vaccinated. The mean time off work or school was 9.6 days. The mean duration of perceived illness was 13.8 days. The mean number of QALYs lost was 0.019 (equivalent to 6.9 days). The overall burden of disease in terms of QALYs lost in England based on the total number of confirmed cases in the twelve month period from 1st June 2012 was estimated to be 44.2 QALYs.

Conclusion: The short-term impact of measles infection on HRQoL is substantial, both at the level of the individual patient and in terms of the overall disease burden. This is the first attempt to quantify QALY-loss due to measles at a population level, and provides important parameters to guide future intervention and control measures.

Figure 1. Illustration of the calculation of short-term loss of health-related quality of life (HRQoL).

HRQoL is plotted against time; the area of the black triangle represents the loss of HRQoL due to illness.

Figure 2. Age-specific distribution of questionnaires sent, questionnaire response, and vaccination status for confirmed cases of measles.

The right columns of each age group show the age-distribution of questionnaires sent to confirmed measles cases (left axis); the left columns show the age-distribution of responses (left axis), split into those who are have received no MMR vaccinations (black), one MMR vaccination (diagonal stripe) and two MMR vaccinations (horizontal stripe).

Figure 3. Flow chart for the study showing the number of questionnaires that were distributed to confirmed measles cases; the number of questionnaires returned for analysis; and the number of questionnaires returned for analysis that included the necessary information for EQ-5D-3L health utilities to be calculated.