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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.
Summary
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.
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.
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