IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v26y2025i7d10.1007_s10198-025-01772-9.html
   My bibliography  Save this article

Psychometric benefits of adding bolt-ons to the EQ-5D-5L in populations undergoing minimally invasive cosmetic procedures

Author

Listed:
  • Eszter Mercédesz Müller

    (Semmelweis University)

  • Anna Nikl

    (Semmelweis University Doctoral School
    Corvinus University of Budapest)

  • Máté Krebs

    (Semmelweis University)

  • Péter Holló

    (Semmelweis University)

  • Valentin Brodszky

    (Corvinus University of Budapest)

  • Lajos Vince Kemény

    (Semmelweis University
    Semmelweis University
    Semmelweis University)

  • Fanni Rencz

    (Semmelweis University Doctoral School
    Corvinus University of Budapest)

Abstract

Objectives There is growing interest in measuring health outcomes associated with minimally invasive cosmetic procedures (MICPs), such as botulinum toxin and hyaluronic acid injections. However, the EQ-5D may have limited content validity for this purpose. This study aims to psychometrically test five additional dimensions (‘bolt-ons’) for the EQ-5D-5L in individuals planning or undergoing MICPs. Methods In 2023, a cross-sectional, online survey was conducted with 149 women planning MICPs and 215 who had recently undergone them. Respondents completed the EQ-5D-5L, five bolt-ons (skin irritation, self-confidence, sleep, social relationships, tiredness), the Rosenberg Self-Esteem Scale (RSES) and the Brief Fear of Negative Evaluation Scale-Straightforward Items (BFNE-S). The following psychometric properties were tested for the EQ-5D-5L + bolt-on(s): ceiling, convergent and divergent validity, explanatory power and known-groups validity. Results Adding tiredness (22%), self-confidence (23%) or sleep bolt-ons (27%) substantially reduced the ceiling of the EQ-5D-5L (47%). The self-confidence and social relationships bolt-ons showed a moderate or strong correlation with the RSES and BFNE-S total scores (-0.462 to -0.679). The tiredness and self-confidence bolt-ons improved the EQ-5D-5L’s explained variance in EQ VAS scores from 37% to 45%. The self-confidence and social relationships bolt-ons improved the EQ-5D-5L’s discrimination between known groups based on self-esteem and bodily appearance (relative efficiency: 2.72 to 2.82). Conclusions Relevant bolt-ons substantially enhance the psychometric performance of the EQ-5D-5L in MICP populations. The self-confidence and tiredness bolt-ons may be recommended as primary choices for use alongside the EQ-5D-5L, both in clinical studies and as part of sensitivity analyses in economic evaluations of MICPs.

Suggested Citation

  • Eszter Mercédesz Müller & Anna Nikl & Máté Krebs & Péter Holló & Valentin Brodszky & Lajos Vince Kemény & Fanni Rencz, 2025. "Psychometric benefits of adding bolt-ons to the EQ-5D-5L in populations undergoing minimally invasive cosmetic procedures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(7), pages 1233-1247, September.
    • Handle: RePEc:spr:eujhec:v:26:y:2025:i:7:d:10.1007_s10198-025-01772-9
    DOI: 10.1007/s10198-025-01772-9
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-025-01772-9
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-025-01772-9?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Koonal Kirit Shah & Brendan Mulhern & Louise Longworth & M. F. Janssen, 2017. "Views of the UK General Public on Important Aspects of Health Not Captured by EQ-5D," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 10(6), pages 701-709, December.
    2. Aureliano Paolo Finch & John Brazier & Clara Mukuria, 2021. "Selecting Bolt-on Dimensions for the EQ-5D: Testing the Impact of Hearing, Sleep, Cognition, Energy, and Relationships on Preferences Using Pairwise Choices," Medical Decision Making, , vol. 41(1), pages 89-99, January.
    3. N. Hamilton & C. Nelson & N. Stevens & Heather Kitzman, 2007. "Sleep and psychological well-being," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 82(1), pages 147-163, May.
    4. Matthew Kennedy-Martin & Bernhard Slaap & Michael Herdman & Mandy Reenen & Tessa Kennedy-Martin & Wolfgang Greiner & Jan Busschbach & Kristina S. Boye, 2020. "Which multi-attribute utility instruments are recommended for use in cost-utility analysis? A review of national health technology assessment (HTA) guidelines," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1245-1257, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Richard Huan Xu & Eliza Lai-yi Wong & Nan Luo & Richard Norman & Jens Lehmann & Bernhard Holzner & Madeleine T. King & Georg Kemmler, 2024. "The EORTC QLU-C10D: the Hong Kong valuation study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(5), pages 889-901, July.
    2. Heyes, Anthony & Zhu, Mingying, 2019. "Air pollution as a cause of sleeplessness: Social media evidence from a panel of Chinese cities," Journal of Environmental Economics and Management, Elsevier, vol. 98(C).
    3. Ole Marten & Wolfgang Greiner, 2023. "Exploring differences and similarities of EQ-5D-3L, EQ-5D-5L and WHOQOL-OLD in recipients of aged care services in Germany," PLOS ONE, Public Library of Science, vol. 18(8), pages 1-18, August.
    4. Mathieu F. Janssen & A. Simon Pickard & James W. Shaw, 2021. "General population normative data for the EQ-5D-3L in the five largest European economies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(9), pages 1467-1475, December.
    5. David Maume & Rachel Sebastian, 2012. "Gender, Nonstandard Work Schedules, and Marital Quality," Journal of Family and Economic Issues, Springer, vol. 33(4), pages 477-490, December.
    6. Friedman, Elliot & Franks, Melissa & Teas, Elizabeth & Thomas, Patricia A., 2024. "Social connectedness, functional capacity, and longevity: A focus on positive relations with others," Social Science & Medicine, Elsevier, vol. 340(C).
    7. Nie, Peng & Sousa-Poza, Alfonso, 2018. "Commute time and subjective well-being in urban China," China Economic Review, Elsevier, vol. 48(C), pages 188-204.
    8. Peasgood, Tessa & Bourke, Mackenzie & Devlin, Nancy & Rowen, Donna & Yang, Yaling & Dalziel, Kim, 2023. "Randomised comparison of online interviews versus face-to-face interviews to value health states," Social Science & Medicine, Elsevier, vol. 323(C).
    9. Sydney A Martinez & Laura A Beebe & David M Thompson & Theodore L Wagener & Deirdra R Terrell & Janis E Campbell, 2018. "A structural equation modeling approach to understanding pathways that connect socioeconomic status and smoking," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-17, February.
    10. Elliott, Jack & Tsuchiya, Aki, 2022. "Do they just know more, or do they also have different preferences? An exploratory analysis of the effects of self-reporting serious health problems on health state valuation," Social Science & Medicine, Elsevier, vol. 315(C).
    11. Ariel Mitev & Fanni Rencz & Béla Tamási & Krisztina Hajdu & Márta Péntek & László Gulácsi & Andrea Szegedi & Zsuzsanna Bata-Csörgő & Ágnes Kinyó & Miklós Sárdy & Valentin Brodszky, 2019. "Subjective well-being in patients with pemphigus: a path analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 101-107, June.
    12. Yang, Yang & Mao, Zhenxing & Zhang, Xiaowei, 2021. "Better sleep, better trip: The effect of sleep quality on tourists' experiences," Annals of Tourism Research, Elsevier, vol. 87(C).
    13. Abeer Rabayah & Bram Roudijk & Fredrick Dermawan Purba & Fanni Rencz & Saad Jaddoua & Uwe Siebert, 2025. "Valuation of the EQ-5D-3L in Jordan," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(3), pages 487-501, April.
    14. Kamilla Koszorú & Krisztina Hajdu & Valentin Brodszky & Alex Bató & L. Hunor Gergely & Anikó Kovács & Zsuzsanna Beretzky & Miklós Sárdy & Andrea Szegedi & Fanni Rencz, 2023. "Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L descriptive systems and utilities in atopic dermatitis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 139-152, February.
    15. Sarah M. Ghose & Morgan P. Reid & Natalie D. Dautovich & Joseph M. Dzierzewski, 2022. "Sleep and Social Wellness: Does Current Subjective and Objective Sleep Inform Future Social Well-Being?," IJERPH, MDPI, vol. 19(18), pages 1-12, September.
    16. Finch, Aureliano Paolo & Mulhern, Brendan, 2022. "Where do measures of health, social care and wellbeing fit within a wider measurement framework? Implications for the measurement of quality of life and the identification of bolt-ons," Social Science & Medicine, Elsevier, vol. 313(C).
    17. Michał Jakubczyk & Michał Lewandowski, 2024. "How sure are you? — the properties of self-reported conviction in the elicitation of health preferences with discrete choice experiments," Theory and Decision, Springer, vol. 96(3), pages 351-368, May.
    18. Michela Meregaglia & Elena Nicod & Michael Drummond, 2023. "The estimation of health state utility values in rare diseases: do the approaches in submissions for NICE technology appraisals reflect the existing literature? A scoping review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(7), pages 1151-1216, September.
    19. Márta Péntek & Viktor Jáger & Áron Kincses & Áron Hölgyesi & Zsombor Zrubka & Petra Baji & Levente Kovács & László Gulácsi, 2025. "Population norms for the EQ-5D-5L for Hungary: comparison of online surveys and computer assisted personal interviews," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(6), pages 1111-1126, August.
    20. Michał Jakubczyk, 2023. "What if 0 is not equal to 0? Inter-personal health utilities anchoring using the largest health gains," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(7), pages 1217-1233, September.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:26:y:2025:i:7:d:10.1007_s10198-025-01772-9. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.