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. 2025 Aug 7;20(8):e0329413.
doi: 10.1371/journal.pone.0329413. eCollection 2025.

Health-related quality of life and QALY loss under COVID-19 lockdown: The case of Spain

Mathieu F Janssen  1   2 , Kim Rand  1 , Anabel Estévez-Carrillo  1 , Juan Manuel Ramos-Goñi  1
Affiliations

Health-related quality of life and QALY loss under COVID-19 lockdown: The case of Spain

Mathieu F Janssen et al. PLoS One. .

Abstract

Objectives: The COVID-19 pandemic forced many countries to implement confinement measures to limit the spread of the virus. Measuring the loss in terms of quality-adjusted life-years (QALYs) may provide a commensurable basis for comparing the impact of COVID-19. The aim of this research was to explore the impact of the first 21 days of COVID-19 lockdown on health-related quality of life (HRQoL) and associated QALY loss of the Spanish general population.

Methods: A quota-based online survey was conducted in four waves with 500 general population respondents each: one conducted shortly before the lockdown (baseline) and 3 follow-ups conducted weekly. HRQoL data were collected using EQ-5D-5L. For comparison with pre-covid responses, data from the 2011-2012 National Health Survey was taken as reference. Data were analyzed using frequency analysis and logistic regression. QALY loss was estimated over the follow-up period and for the entire duration of the lockdown.

Results: Comparing the baseline results to the follow-up results shows little change with respect to the distributions of reported problems in any of the 5 dimensions during the follow-up period. However, results for anxiety/depression show a 32% increase in the proportion of reported problems. The Spanish population was estimated to accrue a total of 1,994,216 QALYs over the study period. Based on the reference data, the population should have accrued 2,054,737 QALYs, leading to a loss of 60,520 QALYs over 21 days. For the entire lockdown, the corresponding loss would be 285,310 QALYs.

Conclusions: A population under a lockdown situation reported higher rates of anxiety/depression problems than in a regular situation. On a country-wide scope, this may lead to a substantial loss in terms of QALYs, especially over longer periods of time. This is the first study to directly assess the impact of the lockdown in terms of QALY loss on a country-wide level.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Proportion of respondents reporting each level of health by EQ-5D dimension (total and stratified by regional epidemic severity and age).
Regional epidemic severity was defined by tertile subgroups of rates of cases per 100,000 members of the population by geographical location.
Fig 2
Fig 2. Distribution of utility and EQ VAS by time, regional epidemic severity, and age represented by notched box-plots*.
Regional epidemic severity was defined by tertile subgroups of rates of cases per 100,000 members of the population by geographical location. * Boxes represent inter-quartile ranges while notches indicate 95% confidence interval around the median. Colored circle areas represent the proportion of respondents assigning a particular value.
Fig 3
Fig 3. QALYs lost representation due to COVID-19 lockdown in Spain over the three week study period.
BL baseline, FU follow-up, QALY quality-adjusted life year.
See this image and copyright information in PMC

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