Psychometric Properties of Cognition Bolt-Ons for the EQ-5D-3L and EQ-5D-5L: A Systematic Review.

Rencz, F; Pangestu, S; Mulhern, B; Finch, AP; Janssen, MF

Psychometric Properties of Cognition Bolt-Ons for the EQ-5D-3L and EQ-5D-5L: A Systematic Review.

Rencz, F Pangestu, S Mulhern, B

Finch, AP Janssen, MF

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Value Health, 2025, pp. S1098-3015(25)05610-4
Issue Date:: 2025-10-02

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Field	Value	Language
dc.contributor.author	Rencz, F
dc.contributor.author	Pangestu, S
dc.contributor.author	Mulhern, B https://orcid.org/0000-0003-3656-8063
dc.contributor.author	Finch, AP
dc.contributor.author	Janssen, MF
dc.date.accessioned	2026-02-19T23:23:56Z
dc.date.available	2025-09-19
dc.date.available	2026-02-19T23:23:56Z
dc.date.issued	2025-10-02
dc.identifier.citation	Value Health, 2025, pp. S1098-3015(25)05610-4
dc.identifier.issn	1098-3015
dc.identifier.issn	1524-4733
dc.identifier.uri	http://hdl.handle.net/10453/193660
dc.description.abstract	OBJECTIVES: Cognition is the most commonly used EQ-5D bolt-on, with many different versions varying by descriptors and response levels (3L vs 5L). We aimed to systematically review the psychometric properties of cognition bolt-ons for the EQ-5D-3L and EQ-5D-5L. METHODS: A systematic review was conducted in PubMed, Web of Science, and Google Scholar following PRISMA 2020 guidelines (PROSPERO:CRD42023445567). We assessed the bolt-ons' performance both as individual items and when added to the EQ-5D. Each bolt-on version was rated as positive (+) or nonpositive (-) within each publication using a checklist, and scores were summed across publications to reflect overall performance. RESULTS: In total, 101 publications from 72 studies met the inclusion criteria, examining 15 3-level and 13 5-level bolt-ons. The most frequently reported psychometric properties were item-level ceiling (n = 75) and known-groups validity (n = 54). Fewer studies explored convergent or divergent validity (n = 8 for each), responsiveness (n = 3), patient-proxy agreement (n = 2), and test-retest reliability (n = 1). None reported on content validity. Five-level bolt-ons outperformed 3-level bolt-ons in terms of overall performance (3L: 55+/57-; 5L: 45+/28-). Supportive psychometric evidence varied by populations, eg, head/brain injury (3L: 11+/11-; 5L: 1+/3-) and dementia (3L: 9+/8-; 5L: 4+/4-). The most-tested bolt-ons were the Janssen 2013 (5L, cognition: 18+/15-) and Haagsma 2005 (3L, thinking ability: 8+/12-) versions, with fewer than 10 assessments for all other bolt-ons. CONCLUSIONS: Despite several publications, the psychometric evidence remains insufficient to identify a preferred cognition descriptor. Future research should prioritize content validity testing to inform the selection of candidate items, with quantitative psychometric evaluation preferably conducted afterward.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Value Health
dc.relation.isbasedon	10.1016/j.jval.2025.09.3053
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1117 Public Health and Health Services, 1402 Applied Economics
dc.subject.classification	Health Policy & Services
dc.subject.classification	3801 Applied economics
dc.subject.classification	4203 Health services and systems
dc.subject.classification	4407 Policy and administration
dc.title	Psychometric Properties of Cognition Bolt-Ons for the EQ-5D-3L and EQ-5D-5L: A Systematic Review.
dc.type	Journal Article
utslib.location.activity	United States
utslib.for	1117 Public Health and Health Services
utslib.for	1402 Applied Economics
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Economics Research and Evaluation (CHERE)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.date.updated	2026-02-19T23:23:53Z
pubs.publication-status	Published online

Abstract:

OBJECTIVES: Cognition is the most commonly used EQ-5D bolt-on, with many different versions varying by descriptors and response levels (3L vs 5L). We aimed to systematically review the psychometric properties of cognition bolt-ons for the EQ-5D-3L and EQ-5D-5L. METHODS: A systematic review was conducted in PubMed, Web of Science, and Google Scholar following PRISMA 2020 guidelines (PROSPERO:CRD42023445567). We assessed the bolt-ons' performance both as individual items and when added to the EQ-5D. Each bolt-on version was rated as positive (+) or nonpositive (-) within each publication using a checklist, and scores were summed across publications to reflect overall performance. RESULTS: In total, 101 publications from 72 studies met the inclusion criteria, examining 15 3-level and 13 5-level bolt-ons. The most frequently reported psychometric properties were item-level ceiling (n = 75) and known-groups validity (n = 54). Fewer studies explored convergent or divergent validity (n = 8 for each), responsiveness (n = 3), patient-proxy agreement (n = 2), and test-retest reliability (n = 1). None reported on content validity. Five-level bolt-ons outperformed 3-level bolt-ons in terms of overall performance (3L: 55+/57-; 5L: 45+/28-). Supportive psychometric evidence varied by populations, eg, head/brain injury (3L: 11+/11-; 5L: 1+/3-) and dementia (3L: 9+/8-; 5L: 4+/4-). The most-tested bolt-ons were the Janssen 2013 (5L, cognition: 18+/15-) and Haagsma 2005 (3L, thinking ability: 8+/12-) versions, with fewer than 10 assessments for all other bolt-ons. CONCLUSIONS: Despite several publications, the psychometric evidence remains insufficient to identify a preferred cognition descriptor. Future research should prioritize content validity testing to inform the selection of candidate items, with quantitative psychometric evaluation preferably conducted afterward.

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http://hdl.handle.net/10453/193660