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Exploring Perceived Interactions between EQ-5D-5L and Bolt-ons Using Composite Time-Tradeoff Valuations: A

Stevanus Pangestu1,2, Fanni Rencz1,2, Bram Roudijk1

  • 1EuroQol Research Foundation, Rotterdam, The Netherlands.

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|May 28, 2026
PubMed
Summary
This summary is machine-generated.

This study explored how additional health aspects, called bolt-ons, affect the perceived importance of the EQ-5D-5L core dimensions. Findings suggest presentation order influences reasoning, with most changes related to measurement rather than preference.

Keywords:
EQ-5D-5LEQ-PVTbolt-oncomposite time tradeoffscaling factor

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Area of Science:

  • Health Economics
  • Psychometrics
  • Patient-Reported Outcomes

Background:

  • The EQ-5D-5L is a widely used measure of health status.
  • Understanding how additional health dimensions (bolt-ons) influence its valuation is crucial for accurate health economic modeling.
  • Previous research has not qualitatively explored this interaction.

Purpose of the Study:

  • To qualitatively explore how bolt-ons impact the perception of EQ-5D-5L core dimensions during health state valuation.
  • To investigate the reasoning behind these perceptual shifts, differentiating between measurement and valuation effects.
  • To examine the influence of presentation order on these effects.

Main Methods:

  • Sixty Indonesian adults valued 10 health states using composite time tradeoff (cTTO).
  • Health states were presented in either forward (EQ-5D-5L, then with bolt-ons) or backward (reversed) order.
  • Participants were assigned to one of three bolt-on dyads (e.g., vision/tiredness) and interviewed about perceived dimension importance shifts.

Main Results:

  • Cognition and vision bolt-ons most frequently shifted perceived importance, depending on presentation order.
  • Most shifts occurred between the EQ-5D-5L alone and the first presented bolt-on state.
  • Changes were predominantly classified as measurement or relative preference shifts, with absolute preference shifts being least common.

Conclusions:

  • Interactions between EQ-5D-5L dimensions and bolt-ons are complex and influenced by presentation order.
  • Reasoning shifts are often based on accessible associations rather than pure preference.
  • Further qualitative and quantitative research is needed to fully understand preferential reasoning and disentangle effects.