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Participants completed EQ-5D-5L, eight bolt-ons (vision, hearing, breathing, sleep, tiredness, social relationships, self-confidence, and cognition\/memory), and sociodemographic and health-related questions. Psychometric assessments included ceiling, convergent\/divergent validity, structural validity, known-groups validity, and explanatory power.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ceiling of the EQ-5D-5L was higher in CN (45%) than NL (32%). In both countries, vision, tiredness, and sleep bolt-ons reduced the ceiling the most, while breathing had the least effect. Tiredness and self-confidence bolt-ons demonstrated stronger associations with the core dimensions. Several bolt-ons significantly improved known-groups validity. In CN, hearing showed stronger known-groups discrimination across age groups, while self-confidence had the greatest impact in NL. The core dimensions explained more variance in EQ VAS in NL (37%) than CN (25%). In both countries, tiredness and self-confidence contributed most to increasing the variance explained. Principal component analysis (PCA) confirmed a seven-factor structure, with all bolt-ons loading separately from the core dimensions. In country-specific PCAs, no major differences were observed between CN and NL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While certain bolt-ons demonstrated robust psychometric properties in both countries, others showed greater context dependence. These findings add to the growing body of evidence supporting the development of the experimental EQ-5D Bolt-on Toolbox.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11136-026-04328-3","type":"journal-article","created":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T07:34:38Z","timestamp":1782632078000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative performance of EQ-5D-5L bolt-ons in China and the Netherlands: results from the EQ-DAPHNIE project"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2307-7014","authenticated-orcid":false,"given":"Seo-Ho","family":"Cho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6602-6949","authenticated-orcid":false,"given":"Mathieu F.","family":"Janssen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3891-5452","authenticated-orcid":false,"given":"Fatima","family":"Al Sayah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7444-1584","authenticated-orcid":false,"given":"Zhuxin","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1509-3409","authenticated-orcid":false,"given":"You-Shan","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8233-1844","authenticated-orcid":false,"given":"Lajos V.","family":"Kem\u00e9ny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9674-620X","authenticated-orcid":false,"given":"Fanni","family":"Rencz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the EQ-DAPHNIE Project Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,28]]},"reference":[{"issue":"10","key":"4328_CR1","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","volume":"20","author":"M Herdman","year":"2011","unstructured":"Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., Bonsel, G., & Badia, X. 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