Abstract
PurposeThe EQ-5D is the most widely applied generic preference-based measure (GPBM) of health-related quality of life (HRQoL). Much concern has been raised that its descriptive system is lacking psycho-social dimensions. A recent paper in this journal provided theoretical support for four dimensions to fill this gap. The current paper aims to provide empirical support for these suggested bolt-on dimensions to the EQ-5D.MethodsWe use data from the comprehensive Multi-Instrument-Comparison (MIC) study. The four proposed bolt-on dimensions (Vitality, Sleep, Social Relationships, and Community Connectedness) were selected from the Assessment of Quality of Life (AQoL)-8D. We investigate the relative importance of these four dimensions as compared to the five EQ-5D-5L dimensions on explaining HRQoL (measured by a visual analogue scale; N = 7846) or global life satisfaction (measured by the Satisfaction With Life Scale; N = 8005), using the Shorrocks-Shapely decomposition analysis. Robustness analyses on Vitality was conducted using data from the United States National Health Measurement Study (NHMS) (N = 3812).ResultsAll five EQ-5D-5L dimensions and four bolt-on dimensions significantly explained the variance of HRQoL. Among them, Vitality was found to be the most important dimension with regard to the HRQoL (relative contribution based on the Shorrocks-Shapely decomposition of R2: 23.0%), followed by Usual Activities (15.1%). Self-Care was the least important dimension (relative contribution: 5.4%). As a comparison, when explaining global life satisfaction, Social Relationships was the most important dimension (relative contribution: 24.0%), followed by Anxiety/Depression (23.2%), while Self-Care remained the least important (relative contribution: 1.6%). The importance of the Vitality dimension in explaining HRQoL was supported in the robustness analysis using the NHMS data (relative contribution: 23.7%).ConclusionsWe provide empirical support for complementing the current EQ-5D-5L descriptive system with a coherent set of four bolt-on dimensions that will fill its psycho-social gap. Such an extended health state classification system would in particular be relevant for programme evaluations within the expanding fields of mental health and community care.
Highlights
The EQ-5D is the most widely applied generic preferencebased measure (GPBM) of health-related quality of life (HRQoL) [1]
The aim of the current paper is to inquire into the empirical support behind four bolt-on dimensions to the EQ-5D that were recently suggested by Olsen and Misajon (O&M) in this journal [5]
In addition to the five EQ-5D-5L dimensions included in MIC, the four bolt-ons proposed by O&M were drawn from the Assessment of Quality of Life (AQoL)-8D instrument [11]
Summary
The EQ-5D is the most widely applied generic preferencebased measure (GPBM) of health-related quality of life (HRQoL) [1]. Quality of Life Research (2020) 29:3119–3129 health. For programme evaluations within wider fields of mental health and community care, we argue that the existing EQ-5D should be complemented by an additional psycho-social part consisting of four bolt-on dimensions. Such an extended descriptive system would be more aligned with the seminal WHO definition that emphasises three key dimensions of health: physical, mental, and social [4]
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