Estimating the Quality-Adjusted Life-Year Loss due to Fatal and Nonfatal COVID-19 Outcomes across US States and Counties, July 2020 to December 2022.

Abstract

Objective: The population-level quality-of-life impact of nonfatal health outcomes, including prolonged hospitalizations and long COVID, remains poorly understood. In this study, we estimate the cumulative quality-adjusted life-year (QALY) loss attributable to fatal and nonfatal COVID-19 outcomes in the United States and compare that burden with that of other diseases.

Methods: We developed a probabilistic model that accounts for the loss in population health due to COVID-19 symptoms, hospitalizations, long COVID, and deaths. The model was applied to weekly county-level data from July 2020 to December 2022. We used appropriate probability distributions to describe uncertainty in parameter values and used 1,000 repeated samples from these distributions to estimate the expected QALY loss and the 95% uncertainty interval (UI).

Results: We estimate the cumulative QALY loss as 9,242,000 (95% UI: 7,808,000-11,311,000) life-years. Following deaths, long COVID was the second most significant contributor to QALY loss, with an estimated annual QALY loss of approximately 865,000 (95% UI: 355,000-1,591,000). This burden is comparable to the total annual disability-adjusted life-years (DALYs) associated with liver cancer: 581,000 DALYs (95% UI: 549,000-607,000). Although symptomatic infections contributed less to overall QALY loss, their burden was comparable to that of HIV/AIDS (377,000 DALYs, 95% UI: 309,000-465,000).

Conclusion: The quality-of-life burden of nonfatal COVID-19 outcomes, particularly long COVID, is on the same scale as that of major chronic and infectious diseases. As COVID-19 mortality declines and the pandemic transitions to an endemic phase, it is essential to recognize and address the long-term effects of nonfatal outcomes as public health priorities.