Testing the Psychometric Properties of 9 Bolt-Ons for the EQ-5D-5L in a General Population Sample

Fanni Rencz; Mathieu F Janssen

doi:10.1016/j.jval.2024.03.2195

Testing the Psychometric Properties of 9 Bolt-Ons for the EQ-5D-5L in a General Population Sample

Value Health. 2024 Apr 9:S1098-3015(24)02310-6. doi: 10.1016/j.jval.2024.03.2195. Online ahead of print.

Authors

Fanni Rencz¹, Mathieu F Janssen²

Affiliations

¹ Department of Health Policy, Corvinus University of Budapest, Hungary, Budapest. Electronic address: fanni.rencz@uni-corvinus.hu.
² Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, The Netherlands, Rotterdam.

PMID: 38599517
DOI: 10.1016/j.jval.2024.03.2195

Abstract

Objectives: We aimed to assess the psychometric performance and added value of 9 existing bolt-ons (breathing problems, cognition, hearing, self-confidence, skin irritation, sleep, social relationships, tiredness, and vision) for the EQ-5D-5L in a general population sample.

Methods: The EQ-5D-5L, 9 bolt-ons, SF-6Dv1, Patient-Reported Outcomes Measurement Information System (PROMIS)-29+2, PROMIS Global Health, and Satisfaction with Life Scale were completed in an online cross-sectional survey among a general adult population sample in Hungary (n = 1587). The following psychometric properties were tested for the EQ-5D-5L + bolt-on(s): ceiling, divergent and convergent validity, structural validity, known-group validity, and explanatory power.

Results: Adding sleep (30%), tiredness (24%), or vision (21%) substantially reduced the ceiling of the EQ-5D-5L (41%). Cognition, sleep, social relationships, and tiredness correlated with corresponding PROMIS and SF-6D items (r_s = ǀ0.32ǀ - ǀ0.73ǀ). All bolt-ons, except cognition and self-confidence, loaded on a different factor from the EQ-5D-5L dimensions. Breathing, hearing, skin irritation, and vision significantly improved known-group validity in relevant health condition groups. The sleep bolt-on improved known-group validity in 9 of 13 chronic health conditions. Tiredness had the largest impact on explaining EQ VAS score variance in 8 of 13 conditions. Hearing and vision improved the ability of the EQ-5D-5L to capture declining health with age, whereas self-confidence and social relationships were valuable for mental health assessment.

Conclusions: This study established the validity of multiple bolt-ons for the EQ-5D-5L and highlights the usefulness of including relevant bolt-ons in population-based and patient surveys. Our findings inform the further development of these bolt-ons and the bolt-on item selection for clinical studies.

Keywords: EQ-5D-5L; bolt-on; health-related quality of life; psychometrics.