The Psychometric Properties of the EQ-HWB and EQ-HWB-S in Patients With Breast Cancer: A Comparative Analysis With EQ-5D-5L, FACT-8D, and SWEMWBS

Associations between financial toxicity, health-related quality of life, and well-being in Indonesian patients with breast cancer

OBJECTIVES

Financial toxicity (FT) is the impairment of financial well-being experienced by patients with cancer, categorized into subjective (SFT) and objective (OFT) forms. This study aimed to investigate the associations between FT, health-related quality of life, and overall well-being in patients with breast cancer.

METHODS

We analyzed baseline data from a single-center longitudinal study in Indonesia. Patients completed the EQ-5D-5L, EQ Health and Wellbeing (EQ-HWB), COST: A FACIT Measure of Financial Toxicity (FACIT-COST, for measuring SFT), and OFT-related questions. Ordinal logistic regression was used to examine the associations between FT and selected EQ-5D-5L and EQ-HWB items. Multivariable linear regression was used to assess the associations of FT and EQ-5D-5L and EQ-HWB-S index values. The main regression models were adjusted for socio-demographic and clinical factors such as age, income, metastasis status, and symptoms.

RESULTS

The survey included 300 female patients with breast cancer undergoing treatment (mean age = 51). Overall, 21% experienced high SFT (FACIT-COST ≤ 17.5) and 51% reported any OFT (e.g., incurring debt). Adjusted for covariates, higher SFT was associated with more problems in EQ-5D-5L pain/discomfort and anxiety/depression, and in EQ-HWB exhaustion, anxiety, sadness/depression, frustration, pain, and discomfort. OFT was associated with more problems in exhaustion. Higher SFT was associated with lower EQ-5D-5L and EQ-HWB-S index values, with explained variances of 46.3% for EQ-HWB-S and 31.2% for EQ-5D-5L.

CONCLUSIONS

This study is the first to explore the associations between financial toxicity, EQ-5D-5L, and EQ-HWB outcomes in breast cancer. Our findings provide insight into the cancer burden and its link to health and well-being.

A Comparative Study of Health and Well-Being Measures in Ireland Using EQ Health and Well-Being (EQ-HWB) and its Short Version, EQ-5D-5L, and ICEpop Capability Measure for Adults (ICECAP-A)

OBJECTIVES

The EQ Health and Wellbeing (EQ-HWB) is a new experimental measure of health and well-being, having been validated in an increasing number of countries and languages. This study aims to examine the psychometric properties of the EQ-HWB and its short version (EQ-HWB-S) in Ireland and compare them with the EQ-5D-5L and ICEpop Capability Measure for Adults (ICECAP-A).

METHODS

A secondary analysis of cross-sectional data from a 2023 Irish general population survey (n = 1220). The survey included the EQ-HWB, EQ-5D-5L, ICECAP-A, and socioeconomic and health-related questions. EQ-HWB-S responses were derived from the EQ-HWB. The UK or Irish value sets were used for each measure to compute index values. Ceiling effects, convergent, divergent validity, and known-group validity were assessed and exploratory factor analysis was conducted.

RESULTS

Mean index values were 0.755, 0.760 to 0.830, and 0.807 for the EQ-HWB-S, EQ-5D-5L, and ICECAP-A, respectively. Ceiling effects were 3%, 7%, 23%, and 15% for EQ-HWB, EQ-HWB-S, EQ-5D-5L, and ICECAP-A. EQ-HWB-S index values correlated strongly with EQ-5D-5L (r = 0.740-0.759) and ICECAP-A (r = 0.604) index values. All measures demonstrated good known-group validity for health-related variables, with EQ-5D-5L performing best overall. Factor analysis identified 5 factors: psychosocial health, pain and discomfort, sensory and physical functioning, capability well-being, and positive psychological states. Feeling settled and secure was the only ICECAP-A item that loaded onto the same factor (psychosocial health) as any of the EQ-HWB items.

CONCLUSIONS

To our knowledge, this is the first study to compare the measurement performance of EQ-HWB and EQ-HWB-S with ICECAP-A. The EQ-HWB and EQ-HWB-S showed good psychometric performance in an Irish population sample. Limited overlap was observed between EQ-HWB and ICECAP-A well-being concepts.

Psychometric Properties of the Modified EQ Health and Wellbeing and its Shorter Version in a General Chinese Population: A Comparative Analysis With EQ-5D-5L, SF-6Dv2, ICEpop CAPability measure for Adults, Short Version of Warwick-Edinburgh Mental Wellbeing Scale, and World Health Organization Well-Being Index 5-Item

OBJECTIVES

The Modified EQ Health and Wellbeing (EQ-HWB) and its shorter version (EQ-HWB-S) are new health and well-being measures nearing finalization. Since the 2022 version, the development group has proposed revisions to the item order, response levels, and wording. This study aimed to assess the psychometric properties of the modified Simplified Chinese EQ-HWB and EQ-HWB-S and compare their performance with other measures.

METHODS

The data were collected through a web-based survey of the Chinese general population (n = 1053). Outcome measures included the modified EQ-HWB, EQ-5D-5L, SF-6Dv2, ICEpop CAPability measure for Adults, short version of Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), and World Health Organization Well-Being Index 5-Item. We examined psychometric properties, such as distributional characteristics (ceiling and floor), convergent (correlations), known-group (effect sizes), and structural validity (principal component analysis).

RESULTS

At the instrument level, neither the modified EQ-HWB nor EQ-HWB-S showed ceiling effect. The response distribution of the 3 items (enjoyable activities, excluded by others, and negative feelings about oneself) modified from positively to negatively framed was in the range of the other items. The EQ-HWB "getting around inside or outside," "day-to-day activities," and "enjoyable activities" items showed only moderate correlations with the corresponding EQ-5D-5L and SF-6Dv2 dimensions (rho = 0.31-0.36). The EQ-HWB items mainly loaded on separate factors from the ICEpop CAPability measure for Adults, short version of Warwick-Edinburgh Mental Wellbeing Scale, and World Health Organization Well-Being Index 5-Item items. The EQ-HWB effectively differentiated between sociodemographic and health-related known groups with larger effect sizes than the EQ-HWB-S.

CONCLUSIONS

The modified EQ-HWB and EQ-HWB-S demonstrated mixed psychometric performance. Several modified items showed improved distributional characteristics compared with earlier findings with the original EQ-HWB. However, item-level correlations were somewhat weaker than those reported in previous studies using the original version.