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

<b>Background and Aims</b>: <br/>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).<br/><br/><b>Methods</b>: <br/>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). HCV transmission model was used to estimate the burden of HCV in terms of morbidity- and mortality-related QALY loss in 2024. <br/><br/><b>Results</b>: <br/>After PSM, 778 individuals remained in each group from a total of 5,468 participants. HCV-positive participants had lower HRQoL (EQ-5D-3L score, p&lt;0.001) and higher odds of problems in all five EQ-5D dimensions. Lower HRQoL was associated with older age, 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.<br/><br/><b>Conclusions</b>: <br/>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.