One-Year Quality of Life Post–Pneumonia Diagnosis in Japanese Adults

• Published in: Clinical infectious diseases 2021-07, Vol.73 (2), p.283-290
• Main Authors: Glick, Henry A, Miyazaki, Taiga, Hirano, Katsuji, Gonzalez, Elisa, Jodar, Luis, Gessner, Bradford D, Isturiz, Raul E, Arguedas, Adriano, Kohno, Shigeru, Suaya, Jose A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Humans; Japan - epidemiology; Major and Commentaries; Male; Pneumonia - diagnosis; Pneumonia - epidemiology; Prospective Studies; Quality of Life; Quality-Adjusted Life Years; Surveys and Questionnaires
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa595

Abstract Background Pneumonia is a common, serious illness in the elderly, with a poorly characterized long-term impact on health-related quality of life (HRQoL). The Japanese Goto Epidemiology Study is a prospective, active, population-based surveillance study of adults with X-ray/CT scan–confirmed community-onset pneumonia, assessing the HRQoL outcome quality-adjusted life-years (QALYs). We report QALY scores and losses among a subset of participants in this study. Methods QALYs were derived from responses to the Japanese version of the EuroQol-5D-5L health-state classification instrument at days 0, 7, 15, 30, 90, 180, and 365 after pneumonia diagnosis from participants enrolled from June 2017 to May 2018. We used patients as their own controls, calculating comparison QALYs by extrapolating EuroQol-5D-5L scores for day −30, accounting for mortality and changes in scores with age. Results Of 405 participants, 85% were aged ≥65 years, 58% were male, and 69% were hospitalized for clinically and radiologically confirmed pneumonia. Compliance with interviews by patients or proxies was 100%. Adjusted EuroQol-5D-5L scores were 0.759, 0.561, 0.702, and 0.689 at days −30, 0 (diagnosis), 180, and 365, respectively. Average scores at all time points remained below the average day −30 scores (P ≤ .001). Pneumonia resulted in a 1-year adjusted loss of 0.13 QALYs (~47.5 quality-adjusted days) (P < .001). Conclusions Substantial QALY losses were observed among Japanese adults following pneumonia diagnosis, and scores had not returned to prediagnosis levels at 1 year postdiagnosis. QALY scores and cumulative losses were comparable to those in US adults with chronic heart failure, stroke, or renal failure. This prospective study evaluated quality-adjusted life-year (QALY) scores and losses due to pneumonia among adults in Japan. The average 1-year QALY loss was 0.13 (P < .001), which is larger than many evaluations of pneumonia-prevention programs assume.