Identifying and developing EQ-5D-5L bolt-on items for Chinese chronic obstructive pulmonary disease patients

This study aimed to identify and develop disease-specific additional items (bolt-ons) for the EQ-5D-5L for patients with chronic obstructive pulmonary disease (COPD) in China. We identified and developed the bolt-ons using a three-step qualitative approach. Step 1: A content review of twenty-five COPD-specific instruments was conducted to identify potential gaps in the dimensions covered by the EQ-5D-5L. Step 2: We conducted semi-structured, face-to-face, one-on-one qualitative interviews with eight physicians and twenty COPD patients to understand patients lived experiences and explore factors influencing their Health-Related Quality of Life (HRQoL). Based on the findings from the first two steps, an initial version of the bolt-ons was developed. Step 3: We conducted Delphi consultations with fifteen experts and conducted cognitive debriefing interviews with eight patients to revise the structure, language, and framing of the bolt-ons. Finally, we invited nine experts to participate in a group discussion, which led to the final selection of the bolt-ons. Through multiple rounds of qualitative methods, “Breathing problems,” “Limitations in physical activities due to shortness of breath,” “Social activities,” “Tiredness/lack of strength,” and “Sleep problems” were identified as the most appropriate bolt-ons for assessing HRQoL in COPD patients. Five bolt-ons were identified as the most relevant candidates for assessing HRQoL in individuals with COPD. Further quantitative validation and analysis will be conducted to determine the final selection.