ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2026
Psychometric benefits of adding four bolt-ons (skin irritation, self-confidence, social relationships and sleep) to EQ-5D-5L compared to PROMIS-29 and Skindex-16 in patients with psoriasis and atopic dermatitis.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to evaluate the impact of adding four bolt-ons (skin irritation (SI), self-confidence (SE), social relationships (SR) and sleep (SL)) on psychometric performance of EQ-5D-5L and compare it to PROMIS-29 and Skindex-16 in patients with psoriasis (Ps) and atopic dermatitis (AD).
methodsPaper-based questionnaires were completed by 125 Ps and 111 AD patients at dermatology outpatient clinics in Egypt, most had moderate-to-severe disease. Psychometric evaluation included ceiling effect, informativity, convergent validity, explanatory power for variances in EQ VAS, and the discriminatory ability across severity subgroups defined by clinical and patient reported indices. Both dimension-level scores and Level Sum Scores (LSS), standardized to a 5-25 scale, were used to assess the psychometric performance of EQ-5D-5L with bolt-ons.
resultsThe EQ-5D-5L showed a low ceiling effect (3.4%), which was eliminated after adding SI bolt-on and reduced to 1.3-3% with the other three bolt-ons. PROMIS-29 and Skindex-16 showed no ceiling effect. Average relative informativity was highest for PROMIS-29 (0.96), followed by EQ-5D-5L+bolt-ons (0.9) and Skindex-16 (0.85). Known-group validity analyses showed that adding bolt-ons produced the highest relative efficiency, outperforming both the core EQ-5D-5L and Skindex-16. EQ-5D-5L + SI explained 51% of EQ VAS variance in Ps, while the combination of all bolt-ons explained 39% in AD; PROMIS-29 and Skindex-16 explained 25% and 21%, respectively. Convergent validity supported predefined hypotheses, with SI and SL showing strongest correlations with clinical outcomes. However, strong correlations were observed between SR and SE with Anxiety/Depression in Ps group.
conclusionAdding bolt-ons enhanced EQ-5D-5L performance across all psychometric properties, making it an acceptable alternative to Skindex-16 in Ps and AD. SI and SL consistently showed the greatest benefits. SE and SR showed selective benefits. Longitudinal data will be published separately.
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