From Infection to Recovery: Health-Related Quality of Life Trajectories Among COVID-19 Patients in Selangor
Author(s)
Alia Daniella Abdul Halim, MD, MPH1, Maznah Dahlui, MPH, PhD2, Awang Bulgiba Awang Mahmud, MPH, PhD3, Amirah Azzeri, MPH, PhD4, Nik Daliana Nik Farid, MPH, DrPH2.
1Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia, 2Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, 3Department of Social and Preventive Medicine, Faculty of Medicine, UniversitI Malaya, Kuala Lumpur, Malaysia, 4Community Health Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia.
1Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia, 2Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, 3Department of Social and Preventive Medicine, Faculty of Medicine, UniversitI Malaya, Kuala Lumpur, Malaysia, 4Community Health Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia.
OBJECTIVES: As the world transitions into the endemic phase of COVID-19, a new challenge emerges: the long-term burden of illness among survivors. Health-related quality of life (HRQoL) outcomes remains poorly understood in low- and middle-income countries, where post-pandemic policy decisions lack localized evidence. This study aimed to map the trajectory of HRQoL recovery in a large cohort of Malaysian COVID-19 survivors and identify key sociodemographic and clinical predictors—critical inputs for value-based post-COVID care and pandemic preparedness.
METHODS: A prospective cohort study involving 2,000 recovered patients was conducted in Selangor, Malaysia. HRQoL was assessed at three intervals—during infection, 3 months, and 6 months post-discharge, using EQ-5D-5L (utility values) and COVID-19-Quality of Life (disease-specific). The CO-19-QoL tool was culturally adapted and validated in accordance with the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines, demonstrating high internal consistency (Cronbach’s α=0.919) and test-retest reliability (ICC=0.896). General Linear Models and repeated measures ANOVA were used to examine HRQoL changes and associated factors.
RESULTS: EQ-5D utility scores improved from 0.33 ± 0.19 (baseline) to 0.54 ± 0.20 (6 months; p<0.001), and EQ-VAS scores rose from 45.50 to 86.38. CO-19-QoL scores declined from 19.49 to 1.89, indicating reduced symptom burden. However, recovery was uneven. Poorer HRQoL trajectories were significantly associated with older age (≥ 60), comorbidities, lower education, private sector employment, overweight BMI, smoking, and severe COVID-19 (Category 4). Socioeconomic disparities were evident; low-income patients (B40) experienced the slowest recovery (p<0.001).
CONCLUSIONS: While overall HRQoL improved, vulnerable groups faced persistent deficits, highlighting the need for targeted post-COVID rehabilitation and equity-driven policies. EQ-5D-derived utility values lay the groundwork for cost-utility analyses and health technology assessments in Malaysia. These findings provide critical evidence for post-pandemic planning and reinforce the importance of integrating HRQoL into future emergency preparedness frameworks.
METHODS: A prospective cohort study involving 2,000 recovered patients was conducted in Selangor, Malaysia. HRQoL was assessed at three intervals—during infection, 3 months, and 6 months post-discharge, using EQ-5D-5L (utility values) and COVID-19-Quality of Life (disease-specific). The CO-19-QoL tool was culturally adapted and validated in accordance with the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines, demonstrating high internal consistency (Cronbach’s α=0.919) and test-retest reliability (ICC=0.896). General Linear Models and repeated measures ANOVA were used to examine HRQoL changes and associated factors.
RESULTS: EQ-5D utility scores improved from 0.33 ± 0.19 (baseline) to 0.54 ± 0.20 (6 months; p<0.001), and EQ-VAS scores rose from 45.50 to 86.38. CO-19-QoL scores declined from 19.49 to 1.89, indicating reduced symptom burden. However, recovery was uneven. Poorer HRQoL trajectories were significantly associated with older age (≥ 60), comorbidities, lower education, private sector employment, overweight BMI, smoking, and severe COVID-19 (Category 4). Socioeconomic disparities were evident; low-income patients (B40) experienced the slowest recovery (p<0.001).
CONCLUSIONS: While overall HRQoL improved, vulnerable groups faced persistent deficits, highlighting the need for targeted post-COVID rehabilitation and equity-driven policies. EQ-5D-derived utility values lay the groundwork for cost-utility analyses and health technology assessments in Malaysia. These findings provide critical evidence for post-pandemic planning and reinforce the importance of integrating HRQoL into future emergency preparedness frameworks.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD1
Topic Subcategory
Data Protection, Integrity, & Quality Assurance
Disease
SDC: Infectious Disease (non-vaccine)