Title: Quality-of-life in patients with long COVID: harnessing the scale of big data to quantify the health and economic costs
Funder: Department of Health and Social Care

Abstract: Standardised metrics of health-related impacts on quality-of-life are used in NHS prioritisation, decision making and vaccination planning. Long COVID may come to represent a large part of the impact of the COVID-19 pandemic, as this condition seems to affect younger people who then require more healthcare and can have long-lasting health and productivity deficits. However, there are no large-scale studies that can assess the individual-level effects of non-hospitalised long Covid, which means the tools for decision making are not in place. This project will use a novel method for collecting large-scale measures of health-related quality-of-life (HRQoL) by using the smartphone app of the UK s second largest GP software provider, TPP. We will deploy validated instruments for HRQoL, as recommended by JCVI and NICE, and link these measurements to the patient's electronic health record (EHR) in the OpenSafely research platform. We will analyse individual-level determinants of HRQoL deficits in long COVID patients including key variables such as ethnicity, age and socioeconomic status, which have already been shown to be critical for COVID-19 outcomes, and we will look ahead at how vaccination may impact long COVID. We will also examine the healthcare utilisation of participants, and relate that to their quality-of-life as well as calculating the economic costs and demand on NHS resources of these healthcare contacts. Critically, we will translate the HRQoL impacts into Quality-adjusted Life Years (QALYs) which is a key unit of measurement used in decision making in the UK. The utility of having standardised QALYs for long COVID will apply to many topics, and we will highlight key demonstration projects, for example using dynamic models for vaccination planning. This project will use novel methods to generate a strong health economic evidence base for assessing the impact of long COVID and evaluating future interventions.

Lay abstract: We want to understand the impacts of long COVID on the quality-of-life of people who have developed this condition. For many health conditions, researchers ask people to fill in standardised surveys which measure quality-of-life, which help them understand how much the condition is affecting people. These kinds of measures are used in planning the resources for health systems, because they allow a standard way of comparing different health conditions, and, if people fill them in repeatedly, tracking changes in wellbeing over time. These quality-of-life measurements are not currently available for people with long COVID who did not need to be hospitalised during their COVID-19 episode. Our study aims to collect these measurements, by using a smartphone app linked to a patient s GP records. We will ask people to voluntarily participate in the study and use the app, and if they do so to give their consent for filling the questionnaires and for linkage to their health records. These results will tell us if long COVID has different quality-of-life impacts among different age groups, ethnicities, geographic regions, or because of any underlying health conditions. We will convert the results into standardised measurements that are used in the NHS to assess the impact of illnesses. This means they will be useful for working out how much the effects of long COVID cost the health service, and how we should prioritise interventions such as vaccines to avoid more people getting long COVID. Together with other researchers studying long COVID we will provide results to support long-term care. At all stages we will work with people affected by long COVID to ensure their input is central to designing the study plans and interpreting the outputs.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.2 HEALTH AND WELFARE ECONOMICS
Health categories: INFECTION