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The outcome indicator, HRQoL, was assessed using the EQ-5D-5L developed by the European Society for Quality of Life (EuroQol), which is the most widely used instrument for assessing HRQoL of general populations across the world.33 Its Chinese version has been validated,28 including a population value set for estimating utility index (UI).29 The EQ-5D-5L has stronger discriminatory power and better convergent validity compared with its predecessor EQ-5D-3L, with a lower ceiling effect: 60.50% had an UI score of 1.000 for the EQ-5D-5L compared with 72.08% for the EQ-5D-3L.34 35

The UI, which is a major feature of the EQ-5D instrument,12 reflects a combination of health functioning in the five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It was derived from population preferences for different health states.36 This study adopted the Chinese value set for the EQ-5D-5L, which has a range from −0.391 to 1.000, with 1.000 indicating the best possible health and a negative score indicating a state worse than death.29

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