Comparative performance of EQ-5D-5L bolt-ons in China and the Netherlands: results from the EQ-DAPHNIE project.

Authors

Seo-Ho Cho, Mathieu F Janssen, Fatima Al Sayah, Zhuxin Mao, You-Shan Feng, Lajos V Kemény, Fanni Rencz, EQ-DAPHNIE Project Team

Published in

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. Volume 35. Issue 8. Jun 28, 2026. Epub Jun 28, 2026.

Abstract

This study compares the psychometric properties of eight EQ-5D-5L bolt-ons in the general populations from two culturally distinct countries: China (CN) and the Netherlands (NL).
As part of the EQ-DAPHNIE project, cross-sectional online surveys were conducted in 2024 with quota-based samples approximating the adult population from CN and the NL. Participants completed EQ-5D-5L, eight bolt-ons (vision, hearing, breathing, sleep, tiredness, social relationships, self-confidence, and cognition/memory), and sociodemographic and health-related questions. Psychometric assessments included ceiling, convergent/divergent validity, structural validity, known-groups validity, and explanatory power.
The ceiling of the EQ-5D-5L was higher in CN (45%) than NL (32%). In both countries, vision, tiredness, and sleep bolt-ons reduced the ceiling the most, while breathing had the least effect. Tiredness and self-confidence bolt-ons demonstrated stronger associations with the core dimensions. Several bolt-ons significantly improved known-groups validity. In CN, hearing showed stronger known-groups discrimination across age groups, while self-confidence had the greatest impact in NL. The core dimensions explained more variance in EQ VAS in NL (37%) than CN (25%). In both countries, tiredness and self-confidence contributed most to increasing the variance explained. Principal component analysis (PCA) confirmed a seven-factor structure, with all bolt-ons loading separately from the core dimensions. In country-specific PCAs, no major differences were observed between CN and NL.
While certain bolt-ons demonstrated robust psychometric properties in both countries, others showed greater context dependence. These findings add to the growing body of evidence supporting the development of the experimental EQ-5D Bolt-on Toolbox.

PMID:
42365574
Bibliographic data and abstract were imported from PubMed on 28 Jun 2026.

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