Relationship between Dermatology Life Quality Index Scores and EQ-5D-5L Utility Values in Adults with Atopic Dermatitis: Development of a Swedish Mapping Model
DOI:
https://doi.org/10.2340/actadv.v106.adv-2025-0277Keywords:
atopic dermatitis, health-related quality of life, DLQI, EQ-5D-5L, mapping, patient-reported outcomesAbstract
Atopic dermatitis (AD) is associated with impaired health-related quality of life (HRQoL), especially in moderate-to-severe disease. The Dermatology Life Quality Index (DLQI) is the most widely used dermatology-specific measure, whereas the EuroQol Five-Dimension, Five-Level questionnaire (EQ-5D-5L), a generic preference-based instrument, assesses health status across diseases. This study examined the relationship between DLQI and EQ-5D-5L in Swedish adults with ADatopic dermatitis and developed a mapping model to estimate EQ-5D-5L utilities from DLQI scores. In this cross-sectional study, 112 Swedish adults with self-reported physician-diagnosed ADatopic dermatitis, recruited through the Swedish Asthma and Allergy Patient Association, completed both questionnaires. DLQI scores correlated strongly and negatively with EQ-5D-5L index values (r=−-0.64, p<0.001). Each 5-point increase in DLQI corresponded on average to a 0.07 decrease in EQ-5D-5L utility. A fractional logit regression model including covariates age, sex, and disease severity, showed good calibration and explained 27 % of the variance in EQ-5D-5L values. These findings demonstrate that DLQI scores meaningfully reflect generic HRQoL among adults with ADatopic dermatitis and can be used to estimate EQ-5D-5L utilities when preference-based data are unavailable. The results enhance understanding of how DLQI relaterelates to overall health status and support the application of DLQI-derived utilities in cost-effectiveness analyses and health technology assessments.
Downloads
References
Bylund S, Kobyletzki LB, Svalstedt M, Svensson Å. Prevalence and incidence of atopic dermatitis: a systematic review. Acta Derm Venereol 2020; 100: adv00160. DOI: https://doi.org/10.2340/00015555-3510
Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 2018; 73: 1284–1293. DOI: https://doi.org/10.1111/all.13401
Sibbald C, Drucker AM. Patient burden of atopic dermatitis. Dermatol Clin 2017; 35: 303–316. DOI: https://doi.org/10.1016/j.det.2017.02.004
Theodosiou G, Montgomery S, Metsini A, Dalgard FJ, Svensson Å, Kobyletzki LB. Burden of atopic dermatitis in Swedish adults: a population-based study. Acta Derm Venereol 2019; 99: 964–970. DOI: https://doi.org/10.2340/00015555-3257
Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol 2014; 134: 1527–1534. DOI: https://doi.org/10.1038/jid.2013.446
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–216. DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x
Cardiff University School of Medicine. Quality of life questionnaires. Cardiff: Cardiff University; 2023. [cited 2023 February 2]. Available from: https://www.cardiff.ac.uk/medicine/resources/quality-of-life-questionnaires/dermatology-life-quality-index
Harmonising Outcome Measures for Eczema Initiative (HOME). Quality of life. 2024. [cited 2024 September 13]. Available from: https://www.homeforeczema.org/research/quality-of-life.aspx
EuroQol Research Foundation. EQ-5D-5L user guide. Version 3.0. 2019. [cited 2023 February 2]. Available from: https://euroqol.org/wp-content/uploads/2023/07/EQ-5D-User-License-Policy-04JUL2023.pdf
Ali FM, Kay R, Finlay AY, Piguet V, Kupfer J, Dalgard F, et al. Mapping of the DLQI scores to EQ-5D utility values using ordinal logistic regression. Qual Life Res 2017; 26: 3025–3034. DOI: https://doi.org/10.1007/s11136-017-1607-4
Vilsbøll AW, Kragh N, Hahn-Pedersen J, Jensen CE. Mapping Dermatology Life Quality Index (DLQI) scores to EQ-5D utility scores using data of patients with atopic dermatitis from the National Health and Wellness Study. Qual Life Res 2020; 29: 2529–2539. DOI: https://doi.org/10.1007/s11136-020-02499-1
Metsini A, Ryen L, Montgomery S, Molarius A, Svensson Å, Von Kobyletzki L. Quality of life and economic burden in Swedish adults with atopic dermatitis: a cross-sectional survey of patient-reported outcomes. Acta Derm Venereol 2026; 106: 0184. DOI: https://doi.org/10.2340/actadv.v106.adv-2025-0184
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191–2194. DOI: https://doi.org/10.1001/jama.2013.281053
Sun S, Chuang LH, Sahlén KG, Lindholm L, Norström F. Estimating a social value set for EQ-5D-5L in Sweden. Health Qual Life Outcomes 2022; 20: 167. DOI: https://doi.org/10.1186/s12955-022-02083-w
Vakharia PP, Chopra R, Sacotte R, Patel N, Immaneni S, White T, et al. Validation of patient-reported global severity of atopic dermatitis in adults. Allergy 2018; 73: 451–458. DOI: https://doi.org/10.1111/all.13309
Silverberg JI, Chiesa Fuxench ZC, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, et al. Content and construct validity, predictors, and distribution of self-reported atopic dermatitis severity in US adults. Ann Allergy Asthma Immunol 2018; 121: 729–734. DOI: https://doi.org/10.1016/j.anai.2018.07.040
Petrou S, Rivero-Arias O, Dakin H, Longworth L, Oppe M, Froud R, et al. The MAPS reporting statement for studies mapping onto generic preference-based outcome measures: explanation and elaboration. Pharmacoeconomics 2015; 33: 993–1011. DOI: https://doi.org/10.1007/s40273-015-0312-9
Longworth L, Rowen D. NICE DSU Technical Support Document 10: the use of mapping methods to estimate health state utility values. Sheffield: NICE Decision Support Unit; 2011. [cited 2025 September 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425834/
Wailoo AJ, Hernandez-Alava M, Manca A, Mejia A, Ray J, Crawford B, et al. Mapping to estimate health-state utility from non-preference-based outcome measures: an ISPOR Good Practices for Outcomes Research Task Force report. Value Health 2017; 20: 18–27. DOI: https://doi.org/10.1016/j.jval.2016.11.006
StataCorp. regress: linear regression. College Station (TX): StataCorp LLC; . [cited 2025 May 18]. Available from: https://www.stata.com/manuals/rregress.pdf
StataCorp. tobit: tobit models. College Station (TX): StataCorp LLC; . [cited 2025 May 18]. Available from: https://www.stata.com/manuals/rtobit.pdf
StataCorp. glm: generalized linear models. College Station (TX): StataCorp LLC; . [cited 2025 May 18]. Available from: https://www.stata.com/manuals/rglm.pdf
Papke LE, Wooldridge JM. Econometric methods for fractional response variables with an application to 401(k) plan participation rates. J Appl Econ 1996; 11: 619–632. DOI: https://doi.org/10.1002/(SICI)1099-1255(199611)11:6<619::AID-JAE418>3.0.CO;2-1
Papke LE, Wooldridge JM. Panel data methods for fractional response variables with an application to test pass rates. J Econom 2008; 145: 121–133. DOI: https://doi.org/10.1016/j.jeconom.2008.05.009
The Analysis Factor. Zero-one inflated beta models for proportion data. 2025. [cited 2025 September 18]. Available from: https://www.theanalysisfactor.com/zero-one-inflated-beta-models-for-proportion-data
Ospina R, Ferrari SLP. A general class of zero-or-one inflated beta regression models. Comput Statis Data Analysis 2012; 56: 1609–1623. DOI: https://doi.org/10.1016/j.csda.2011.10.005
Koszorú K, Hajdu K, Brodszky V, Bató A, Gergely LH, Kovács A, et al. Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L descriptive systems and utilities in atopic dermatitis. Eur J Health Econ 2023; 24: 139–152. DOI: https://doi.org/10.1007/s10198-022-01460-y
Buchholz I, Spitzer C, Thiem A, Lübke L, Wülfing C, Emmert S, et al. Psychometric performance of skin, self-confidence, and social health-related EQ-5D-5L bolt-ons in patients with atopic dermatitis and psoriasis in Germany. Value Health 2026; 29: 429–440. DOI: https://doi.org/10.1016/j.jval.2025.10.008
Poór AK, Rencz F, Brodszky V, Gulácsi L, Beretzky Z, Hidvégi B, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L in psoriasis patients. Qual Life Res 2017; 26: 3409–3419. DOI: https://doi.org/10.1007/s11136-017-1699-x
Blome C, Beikert FC, Rustenbach SJ, Augustin M. Mapping DLQI on EQ-5D in psoriasis: transformation of skin-specific health-related quality of life into utilities. Arch Dermatol Res 2013; 305: 197–204. DOI: https://doi.org/10.1007/s00403-012-1309-2
Brazier JE, Yang Y, Tsuchiya A, Rowen DL. A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures. Eur J Health Econ 2010; 11: 215–225. DOI: https://doi.org/10.1007/s10198-009-0168-z
Herédi E, Rencz F, Balogh O, Gulácsi L, Herszényi K, Holló P, et al. Exploring the relationship between EQ-5D, DLQI and PASI, and mapping EQ-5D utilities: a cross-sectional study in psoriasis from Hungary. Eur J Health Econ 2014; 15 Suppl 1: S111–9. DOI: https://doi.org/10.1007/s10198-014-0600-x
Davison NJ, Thompson AJ, Turner AJ, Longworth L, McElhone K, Griffiths CEM, et al. Generating EQ-5D-3L utility scores from the Dermatology Life Quality Index: a mapping study in patients with psoriasis. Value Health 2018; 21: 1010–1018. DOI: https://doi.org/10.1016/j.jval.2017.10.024
Jian L, Wang X, Hu K, Duan Y, Zhang M, Li W, et al. Mapping Dermatology Life Quality Index with EQ-5D health utility index score in Chinese patients with moderate to severe psoriasis. J Comp Eff Res 2025; 14: e250039. DOI: https://doi.org/10.57264/cer-2025-0039
Cheng LJ, Pan T, Chen LA, Cheng JY, Mulhern B, Devlin N, et al. The ceiling effects of EQ-5D-3L and 5L in general population health surveys: a systematic review and meta-analysis. Value Health 2024; 27: 986–997. DOI: https://doi.org/10.1016/j.jval.2024.02.018
Hernández Alava M, Wailoo A, Pudney S, Gray L, Manca A. Mapping clinical outcomes to generic preference-based outcome measures: development and comparison of methods. Health Technol Assess 2020; 24: 1–68. DOI: https://doi.org/10.3310/hta24340
Ferrari SLP, Cribari-Neto F. Beta regression for modelling rates and proportions. J Appl Stat 2004; 31: 799–815. DOI: https://doi.org/10.1080/0266476042000214501
Ismail A, Tilling C, Raftery J, Sculpher M, Ramos IC, Hernandez Alava M. Mapping analyses for health technology assessment: a systematic review and recommendations for best practice. Value Health 2019; 22: 485–495.
Dakin H, Abel L, Burns R, Yang Y, Wordsworth S. Review and critical appraisal of studies mapping from quality of life or clinical measures to EQ-5D: an online database and application of the MAPS statement. Health Qual Life Outcomes 2013; 11: 151. DOI: https://doi.org/10.1186/1477-7525-11-151
SwedAD - Swedish National Atopic Dermatitis Registry. wedAD website. 2024. [cited 2025 November 10]. Available from: https://swedad.nu.
Additional Files
Published
How to Cite
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
