Performance of the EQ-5D-5L plus respiratory bolt-on in the Birmingham COPD Cohort Study

Research output: Contribution to journalArticlepeer-review


  • Martine Hoogendoorn
  • Alexandra Enocson
  • Matthijs Versteegh
  • Maureen Rutten-van Mölken

Colleges, School and Institutes


Objectives: A respiratory bolt-on dimension for the EQ-5D-5L has recently been developed and valued by the general public. This current study aimed to validate the EQ-5D-5L plus respiratory dimension (EQ-5D-5L+R) in a large group of COPD patients.

Methods: Validation was undertaken with data from the Birmingham COPD cohort study (BCCS), a longitudinal UK study of COPD primary care patients. Data on the EQ-5D-5L+R were collected from 1,008 responding participants during a follow-up questionnaire in 2017 and combined with (previously collected) data on patient and disease characteristics. Descriptive and correlation analyses were performed on the EQ-5D-5L+R dimensions and utilities, in relation to COPD characteristics and compared to the EQ-5D-5L without respiratory dimension. Multivariate regression models were estimated to test whether regression coefficients of clinical characteristics differed between the EQ-5D-5L+R utility and the EQ-5D-5L utility.

Results: Correlation coefficients for the EQ-5D-5L+R utility with COPD parameters were slightly higher compared to the EQ-5D-5L utility. Both instruments displayed discriminant validity but analyses in clinical subgroups of patients showed larger absolute differences in utilities for the EQ-5D-5L+R. In the multivariate analyses, only the coefficient for the CAT score was higher for the model using the EQ-5D-5L+R utility as outcome.

Conclusions: This study showed that the addition of a respiratory domain to the EQ-5D-5L led to small improvements in the instrument’s performance. Comparability of the EQ-5D across diseases, currently considered one of its strengths, would have to be traded-off against a modest improvement in utility difference when adding the respiratory dimension

Bibliographic note

Final Version of Record not yet available as of 26/08/2021.


Original languageEnglish
JournalValue in Health
Publication statusAccepted/In press - 18 May 2021


  • COPD, EQ-5D, respiratory dimension, validation