HRQoL are patient reported outcomes. HRQoL measures are types/subsets of patient-reported outcome measures (PROMs) distinguished by incorporating different domains.

Current approaches to measuring HRQoL 

There are many dimensions or domains related to HRQoL that need adequate methods of measurement. Simply asking a patient, ‘How is your health-related quality of life, on a scale of 1 to 10?’ provides limited information. Patients perceive and report the same conditions in different ways. Measuring HRQoL usually requires capturing various dimensions of what is important to patients.

Health-related quality of life (HRQoL) is a type of patient-reported outcome (PRO)—specifically, a subset of patient-reported outcome measures (PROMs) that capture multiple domains relevant to how patients experience their health and treatment.

Measuring HRQoL goes beyond asking general questions like "How is your health-related quality of life on a scale from 1 to 10?" Such a question may not capture key nuances.

For example:

The overall answer to the simple question could be the same from day to day but does not consider that a person’s level of independence might be improving while psychologically they are deteriorating. That is, it may not distinguish between a severely depressed and very mobile patient and another patient who has very limited physical functionality but who is emotionally well.

It should be considered that some domains (such as psychological vs physical functions) are valued more by patients than others, and this will be reflected in a patient’s reported HRQoL status.

Over time, different aspects of a patient’s condition may change in opposite directions—improving physical function while psychological well-being declines.

This highlights the importance of assessing multiple domains—such as physical, psychological, functional, and social well-being—since patients place different value on these aspects, which in turn influences their HRQoL.

Tools for measuring the HRQoL

HRQoL is typically measured through validated questionnaires. Commonly used tools include:

  • SF-36® (36-Item Short Form Survey)
  • EQ-5D (EuroQoL 5-Dimension)

These are widely used in HTA and economic evaluation because they can be converted into numerical values, allowing comparison across conditions and interventions.

Additionally, disease-specific instruments have been developed, such as:

  • HIV-QL31 for patients with HIV
  • EORTC QLQ-C30 for cancer patients

These tools enable more sensitive and relevant assessments tailored to specific patient populations.

Considerations for Use

As with other PROs, the choice and timing of HRQoL instruments in clinical studies must be planned carefully:

  • Instruments should be validated and fit-for-purpose before the study begins
  • Inappropriate or poorly designed tools may misrepresent reality or fail to capture meaningful changes

📚 See also Lesson 2 of this course for more on Patient Reported Outcomes (PROs).

Alternative approaches to measuring HRQoL

Health-related quality of life (HRQoL) is a critical component of evaluating care, but there are additional important dimensions beyond just the quality or duration of life. These include: 

  • The quality of life of caregivers and family members 
  • Convenience and burden of treatment for patients 
  • Consideration of unmet needs 
  • Recognition that the very old or very sick may place higher value on small health gains

The field of HRQoL measurement is both rich and contested. While some advocate for new measures, others support modifying existing tools. However, reaching consensus is challenging: 

  • Stakeholders often disagree on what should be measured and how
  • Health systems heavily reliant on a single measure may resist changes that disrupt prior decisions 

Despite these challenges, one point of agreement remains: 

✅ Investments in HRQoL measurement should only be made when a minimum standard of quality is ensured. Where feasible, the use of multiple complementary measures is encouraged.