BACKGROUND: Generic preference-based measures were criticized for being inappropriate in some conditions. One solution is to include "bolt-on" dimensions describing additional specific health problems. OBJECTIVES: This study aimed to develop bolt-on dimensions to the EuroQol five-dimensional questionnaire (EQ-5D) and assess their impact on health state values. METHODS: Bolt-on dimensions were developed for vision problems, hearing problems, and tiredness. Each bolt-on dimension had three severity levels to match the EQ-5D. Three "core" EQ-5D states across a range of severity were selected, and each level of a bolt-on item was added, resulting in nine states in each condition. Health states with and without the bolt-on dimensions were valued by 300 members of the UK general public using time trade-off in face-to-face interviews, and mean health state values were compared using t tests. Regression analysis examined the impact of the bolt-on variants and the level of the bolt-on items after controlling for sociodemographic characteristics. RESULTS: Bolt-on dimensions had an impact on health state values of the EQ-5D; however, the size, direction, and significance of the impact depend on the severity of the core EQ-5D state and of the bolt-on dimension. Regression analysis demonstrated that after controlling for possible differences in sociodemographic characteristics between the groups, there were no significant differences in health state values between the three bolt-on dimensions but confirmed that the impact depended on the severity of the EQ-5D health state and the levels of bolt-on dimensions. CONCLUSIONS: The impact of a bolt-on dimension on the EQ-5D depends on the core health state and the level of the bolt-on dimension. Further research in this area is encouraged.

Original publication




Journal article


Value Health

Publication Date





52 - 60


EQ-5D, bolt-on, health state valuation, hearing, tiredness, vision, Adolescent, Adult, Aged, Europe, Fatigue, Female, Health Status, Hearing Disorders, Humans, Male, Middle Aged, Quality of Life, Surveys and Questionnaires, Vision Disorders, Young Adult