The added value of the cognition, dining, gastrointestinal problems, sleep and tiredness bolt-on dimensions to the EQ-5D-5L in patients with coeliac disease

M. Mercédesz Angyal, Mathieu F. Janssen, Péter L. Lakatos, Valentin Brodszky and Fanni Rencz ()
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M. Mercédesz Angyal: Semmelweis University Doctoral School
Mathieu F. Janssen: Erasmus MC
Péter L. Lakatos: McGill University Health Centre, Montreal General Hospital
Fanni Rencz: Semmelweis University Doctoral School

The European Journal of Health Economics, 2025, vol. 26, issue 3, No 9, 473-485

Abstract: Abstract Objectives Multiple studies suggest that the EQ-5D may overestimate health-related quality of life (HRQoL) in patients with coeliac disease (CD). We aimed to develop and psychometrically test potentially relevant bolt-on dimensions to improve the measurement performance of the EQ-5D-5L in CD patients. Methods The development and selection of bolt-ons were informed by a literature review on HRQoL in CD, expert and patient input. A cross-sectional online survey was conducted amongst 312 adult CD patients. Respondents completed the EQ-5D-5L, two condition-specific bolt-ons newly-developed for the present study [dining (DI) and gastrointestinal problems (GI)] and three existing bolt-ons [cognition (CO), sleep (SL) and tiredness (TI)]. The following psychometric properties were tested: ceiling, informativity, convergent and known-group validity, and dimensionality (confirmatory factor analysis). Results Adding the TI, SL, GI, DI and CO individual bolt-ons reduced the ceiling of the EQ-5D-5L (39%) to 17%, 23%, 24%, 26% and 37%, respectively. GI excelled with strong convergent validity with the Gastrointestinal Symptom Rating Scale total score (rs=0.71) and improved the discriminatory power for all known-groups. GI was the only bolt-on loading on a different factor from the five core dimensions, whereas the other four bolt-ons loaded onto the same ‘psychosocial health’ factor as the EQ-5D-5L anxiety/depression dimension. Conclusion The DI, GI, SL and TI bolt-ons, especially the GI, enhance the validity of EQ-5D-5L in patients with CD, suggesting their value in capturing important HRQoL aspects potentially missed by the five core dimensions. These bolt-ons can be used in sensitivity analyses supporting health technology assessments and subsequent resource allocation decisions.

Keywords: Coeliac disease; EQ-5D; Bolt-ons; Health-related quality of life; Psychometric properties (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10198-024-01719-6

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