Extending the EQ-5D: the case for a complementary set of 4 psycho-social dimensions

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Objectives: The EQ-5D is the most widely applied preference-based health-related quality of life measure. However, concerns have been raised that the existing dimensional structure lacks sufficient components of mental and social aspects of health. This study empirically explored the performance of a coherent set of four psycho-social bolt-ons: Vitality; Sleep; Personal relationships; and Social isolation. Methods: Cross-sectional surveys were conducted with online panel members from five countries (Australia, Canada, Norway, UK, US) (total N = 4786). Four bolt-ons were described using terms aligned with EQ nomenclature. Latent structures among all nine dimensions are studied using an exploratory factor analysis (EFA). The Shorrocks-Shapely decomposition analyses are conducted to illustrate the relative importance of the nine dimensions in explaining two outcome measures for health (EQ-VAS, satisfaction with health) and two for subjective well-being (the hedonic approach of global life satisfaction and an eudemonic item on meaningfulness). Sub-group analyses are performed on older adults (65 +) and socially disadvantaged groups. Results: Strength of correlations among four bolt-ons ranges from 0.34 to 0.49. As for their correlations with the EQ-5D dimensions, they are generally much less correlated with four physical health dimensions than with mental health dimensions (ranged from 0.21 to 0.50). The EFA identifies two latent factors. When explaining health, Vitality is the most important. When explaining subjective well-being, Social isolation is second most important, after Anxiety/depression. Conclusion: We provide evidence that further complementing the current EQ-5D-5L health state classification system with a coherent set of four bolt-on dimensions that will fill its psycho-social gap.

Original languageEnglish
Pages (from-to)495-505
Number of pages11
JournalQuality of Life Research
Publication statusPublished - 2023


  • Bolt-on
  • EQ-5D
  • Health utility
  • Health-related quality of life
  • Subjective well-being

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