OBJECTIVES:  Joint damage remains a major complication associated with haemophilia and is widely accepted as one of the most debilitating symptoms for persons with severe haemophilia. The aim of this study is to describe how complications of haemophilia such as target joints (TJs) influence health-related quality of life (HRQoL). METHODS:  Data were drawn from the ‘Cost of Haemophilia across Europe – a Socioeconomic Survey’ (CHESS) study, a cost-of-illness assessment in severe haemophilia A and B across five European countries (France, Germany, Italy, Spain, and the UK). Physicians provided clinical and sociodemographic information for 1,285 adult patients, 551 of whom completed corresponding questionnaires, including EQ-5D-3L and EQ VAS. A generalised linear model was developed to investigate the relationship between patient-reported EQ-5D index score and TJs (defined in the CHESS study as areas of chronic synovitis), adjusted for patient covariates including socio-demographic characteristics and comorbidities. Patients with a diagnosed inhibitor at the time of reporting (n=58) were excluded from the analysis. RESULTS:  Five hundred and fifteen patients (42% of the sample) provided an EQ-5D-3L response; a total of 692 TJs were recorded across the sample. Mean reported EQ-5D index score for patients with no TJs was 0.875 (standard deviation (SD) 0.179); for patients with one or more TJs, mean EQ-5D was 0.731 (SD 0.285). Compared to having no TJs, having one or more TJs was associated with poorer mean EQ-5D-3L index scores (average marginal effect (AME) -0.120; SD 0.0262; p<0.000). CONCLUSIONS:  This study found that the presence of one or more TJs has a significant negative impact on HRQoL for adults with severe haemophilia. Prevention and management of TJs should be an important consideration of managing haemophilia patients.