ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2025
Psychometric benefits of adding bolt-ons to the EQ-5D-5L in populations undergoing minimally invasive cosmetic procedures.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Comparative exploration of EQ-5D-5L bolt-on variants for fatigue, sleep, and vision in a general population sample.Health and quality of life outcomes · 2026Article
- Comparative performance of EQ-5D-5L bolt-ons in China and the Netherlands: results from the EQ-DAPHNIE project.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026Article
- Psychometric properties of four FACE-Q Aesthetics scales in patients planning and undergoing minimally invasive facial cosmetic procedures.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026Article
- Qualitative testing of the EQ-HWB-9 with a 'blank' EQ-HWB VAS and EQ-5D-5L with skin bolt-ons in a rare genetic skin disease population.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026Article
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7 authors.
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Abstract
objectivesThere 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.
methodsIn 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.
resultsAdding 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).
conclusionsRelevant 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.
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