Health-Related Quality of Life

Health-related quality of life (HRQoL) is a multidimensional concept describing how a person's health affects their physical, mental, and social well-being and functioning. As a measurement construct, it underpins generic instruments and preference-based indices that quantify the impact of illness and treatment on a patient's life, going beyond survival or biological measures alone.

Definition

Health-related quality of life is the aspect of overall quality of life that is determined by a person's health, encompassing the physical, psychological, and social dimensions of well-being and functioning as affected by disease, injury, treatment, or policy.

Scope

The entry covers the multidimensional nature of HRQoL, the difference between descriptive profile measures and preference-based (utility) measures, and the role of utility values in summarizing health into a single index. It treats HRQoL as a measurement and conceptual topic within patient-reported outcomes, not as clinical guidance, and notes its links to economic evaluation without prescribing any treatment.

Core questions

• Which dimensions of life are considered to be health-related, and how are they captured in a measure?
• How do descriptive profile measures differ from preference-based (utility) measures?
• How can a multidimensional construct be summarized into a single index value, and what is gained or lost in doing so?

Key concepts

• Multidimensionality: physical, mental, social domains
• Profile measures versus preference-based (utility) measures
• Health-state utility values
• Generic versus condition-specific HRQoL measures
• Quality-adjusted life year (as an application)
• Response shift

Mechanisms

HRQoL instruments operationalize the construct as a set of domains — typically physical functioning, mental or emotional health, and social functioning — that patients rate. Profile measures such as the SF-36 report a score for each domain, describing the pattern of health. Preference-based measures such as the EQ-5D combine a small descriptive system with population-derived value sets, so that each health state is assigned a single utility value anchored between death and full health; these utilities can be combined with survival time in economic evaluation. Item-banking initiatives such as PROMIS extend HRQoL measurement across many domains on a common calibrated metric.

Clinical relevance

HRQoL measures describe the burden of illness and the effect of interventions from the patient's perspective, and they feed into both quality monitoring and the economic evaluation of health technologies. This entry explains the construct and how it is measured; it is reference material and does not provide guidance for an individual patient's diagnosis or treatment.

Evidence & guidelines

Widely used reference instruments include the SF-36 profile measure (Ware and Sherbourne) and the preference-based EQ-5D developed by the EuroQol Group, whose utility values support cost-effectiveness analysis. The PROMIS initiative (Cella and colleagues) applied item-response-theory methods to build calibrated item banks spanning physical, mental, and social health, broadening how HRQoL is measured.

History

Interest in measuring health beyond mortality grew through the 1970s and 1980s, drawing on the World Health Organization's broad definition of health. The SF-36 (1992) became a landmark generic profile measure, and the EuroQol Group's EQ-5D (1990) established a compact preference-based descriptive system whose utility values link HRQoL to economic evaluation. Item-response-theory approaches such as PROMIS later modernized measurement across domains.

Debates

Profile versus preference-based measurement

Profile measures preserve detail across domains but cannot be reduced to a single comparable value, while preference-based measures yield a single utility index useful for economic evaluation at the cost of compressing the underlying detail; the choice depends on the purpose of measurement.

Key figures

• John Ware
• David Cella

Seminal works

• ware-1992
• euroqol-1990
• cella-2010

Frequently asked questions

Is health-related quality of life the same as overall quality of life?

No. Health-related quality of life focuses on the dimensions of well-being and functioning that are affected by health, whereas overall quality of life also includes factors such as finances, environment, and relationships that lie outside the health system's scope.

What is the difference between a profile measure and a preference-based measure?

A profile measure reports separate scores for several health domains, while a preference-based measure combines a descriptive system with population values to produce a single utility index that can be used in economic evaluation.