Covid-19 has caused significant psychological and physiological stress to patients and their families worldwide. This study examined the HRQOL of Covid-19 patients using the EQ-5D-3L and VAS tools. The mean EQ-5D index score among Covid-19 patients on discharge was 0.688 (median = 0.787), and the overall mean VAS score was 0.690 (median = 0.700). The utility values from the EQ-5D were consistent with the results of the VAS in our study (Table 2 and Table 3). In general, these findings are in line with those of a study in Iran that reports an EQ-5D index score of 0.612  and of a Belgian study with an EQ-5D index score of 0.620 , but our findings are substantially lower than those of studies from Norway (EQ-5D index score: 0.820) , China (EQ-5D index score: 0.949) and Hong Kong (EQ-5D index score: 0.897) [18, 19].
The variation in age distribution may be a driver of variation in HRQOL across countries, and the population in our study was relatively younger (mean age = 40) than in other places. Age was also a significant predictor of health utility status for Covid-19 patients in our study (Table 4). Older people had a significantly lower HRQOL than younger people, a finding in line with those of studies in Saudi Arabia and Argentina [20, 21]. This variation may be due to increased mental stress, comorbidity and debilitation in the physical condition of older people . Variations in the HRQOL evaluation method employed (i.e., health utility tariff, tools, scale, study participant sampling) may also, to some extent, contribute to the discrepancy. The studies in Italy and China employed the SF-36 instrument, and those in Iran, Argentina, Belgium and Norway employed the EQ-5D-5L instrument, while the Saudi Arabian study, by contrast, employed the WHO’s 12-item Quality of Life instrument.
According to our study, comorbidity, especially asthma (Table 4), is a significant predictor of low health utility scores (Table 2). The mean EQ-5D index scores were significantly lower for respondents with comorbidity (0.574) than for those without it (0.777) (p < .001). In general, comorbidities (such as hypertension, chronic cardiac diseases, chronic pulmonary disease, asthma, chronic kidney disease and diabetes mellitus) were significant predictors of low EQ-5D scores. Studies from Vietnam , Saudi Arabia  and China  reveal that individuals with chronic diseases have a lower HRQOL than those without comorbid disease, perhaps because those with comorbidities develop anxiety or depression in response to misinformation disseminated about the impact of the virus in these communities [20, 24].
We found that Covid-19 patients who received dexamethasone and intranasal oxygen supplementation had lower EQ-5D index scores than those who did not receive them (p < .001), perhaps because those who needed those treatments had a severe form of the illness. Furthermore, those with a length of stay (LOS) of more than 15 days in hospital had lower EQ-5D index scores than their counterparts. Studies from China and Argentina also revealed that increased LOS is associated with poor HRQOL [10, 21, 25]. This poor HRQOL might be due to confinement to one place, increasing anxiety and reducing the HRQOL in general.
To the best of our knowledge, this study represents the first comprehensive analysis of the HRQOL of Covid-19 patients in the Ethiopian setting. We conducted the study in a setting that accommodated patients from 28 districts so that the results can be generalised to similar settings. However, our study has some limitations. First, because the study collected HRQOL data based on patient preferences, the patients may have underestimated or overestimated their status during the interview. In addition, this study used the Zimbabwe tariff due to the lack of an Ethiopian tariff, and this limitation could impact the estimation of the real Ethiopian HRQOL against the disease, as there are many differences between the two countries. Moreover, due to the study’s cross-sectional design, we could not compare the HRQOL of patients before the Covid-19 infection.