# The Impact of Hepatitis C and Socio‐Demographic Variables on Health‐Related Quality of Life in Pakistan: Cross‐Sectional Study

## TL;DR

This study in Pakistan finds that hepatitis C and socio-demographic factors significantly reduce health-related quality of life and cause large quality-adjusted life year losses.

## Contribution

The study quantifies the impact of HCV and socio-demographic variables on HRQoL and QALY loss in Pakistan using a cross-sectional design and PSM.

## Key findings

- HCV-positive individuals had significantly lower HRQoL scores and higher odds of problems in all five EQ-5D dimensions.
- Approximately 804,580 QALYs were estimated to be lost in Pakistan in 2024 due to HCV, with 55% attributed to mortality.
- Socio-demographic factors like age, unemployment, and marital status were strongly associated with HRQoL outcomes.

## Abstract

Approximately 8.8 million people are living with chronic hepatitis C virus (HCV) in Pakistan. We assessed factors related to health‐related quality of life (HRQoL) among the general population screened for HCV and calculated the national burden in quality‐adjusted life years (QALYs). A cross‐sectional study was conducted in community and clinic‐based settings in Karachi and Gujranwala. HRQoL was assessed before diagnosis using EQ‐5D‐3L (Pakistan value set). Propensity score matching (PSM) was used to address socio‐economic differences between HCV RNA‐positive (viraemic) and HCV‐antibody‐negative participants. We assessed socio‐demographic and HCV‐related predictors of HRQoL (Tobit regression) and problems by EQ‐5D domain (logistic regression). The HCV transmission model was used to estimate the burden of HCV in terms of morbidity‐ and mortality‐related QALY loss in 2024. After PSM, 778 individuals remained in each group from a total of 5468 participants. HCV‐positive participants had lower HRQoL (EQ‐5D‐3L score, p < 0.001) and higher odds of problems in all five EQ‐5D dimensions. Lower HRQoL was associated with older age and unemployment, while married or Urdu‐speaking participants had higher HRQoL. There was little evidence that cirrhosis was associated with HRQoL (p = 0.140) among HCV‐positive participants. The total estimated QALY loss due to HCV in Pakistan in 2024 was 804,580 QALYs, of which 55% was due to mortality. HCV infection is associated with reduced HRQoL and substantial QALY losses in Pakistan. Our findings emphasise the role of socio‐demographic variables on HRQoL. Further research in Pakistan is needed to determine if HCV treatment can mitigate these effects.