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The European Journal of Health Economics

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01-05-2017 | Original Paper

Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece

Authors: John N. Yfantopoulos, Athanasios E. Chantzaras

Published in: The European Journal of Health Economics | Issue 4/2017

Abstract

Purpose

To validate and compare the psychometric properties of the EQ-5D-3L with the EQ-5D-5L classification systems in Greece.

Methods

Participants (n = 2279) over 40 years old, sampled from the greater area of Athens using a multistage stratified quota sampling method, completed both EQ-5D versions, while information was also collected on socio-demographics and health-related characteristics. The EQ-5D-5L and EQ-5D-3L were evaluated in terms of agreement, ceiling effects, redistribution and inconsistency, informativity, and convergent and known-groups validity.

Results

The agreement between the EQ-5D-3L and EQ-5D-5L was high (ICC = 0.85). Ceiling effects decreased significantly in the EQ-5D-5L in all domains (P < 0.001), with “usual activities” (−21.4 %) and “self-care” (−20.1 %) showing the highest absolute and “anxiety/depression” the highest relative reduction (−32.46 %). Inconsistency was low (5.7 %). The increase in prevalence of problems was larger than the decrease in their severity, resulting in a lower mean health utility for the EQ-5D-5L. Overall absolute and relative informativity improved by 70.5 % and 16.4 %, respectively, in the EQ-5D-5L. Both instruments exhibited good convergent and known-groups validity, with evidence of a considerably better convergent performance and discriminatory ability of the EQ-5D-5L.

Conclusions

Both EQ-5D versions demonstrated good construct validity and had consistent redistribution. The EQ-5D-5L system may be preferable to the EQ-5D-3L, as it exhibited superior performance in terms of lower ceiling effects, higher absolute and relative informativity, and improved convergent and known-groups validity efficiency.

Available only for authorised users

EuroQol: EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3), 199–208 (1990)

Rabin, R., Oemar, M., Oppe, M.: EQ-5D-3L User Guide, Version 4.0. Rotterdam, The Netherlands: EuroQoL Group (2011)

Rabin, R., Oemar, M., Oppe, M., Janssen, B., Herdman, M.: EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. Version 1.0. In. EuroQol Group, (2011)

Craig, B.M., Pickard, A.S., Lubetkin, E.I.: Health problems are more common, but less severe when measured using newer EQ-5D versions. J. Clin. Epidemiol. 67(1), 93–99 (2014). doi:10.1016/j.jclinepi.2013.07.011 CrossRefPubMed

Brussoni, M., Kruse, S., Walker, K.: Validity and reliability of the EQ-5D-3L™ among a paediatric injury population. Health Qual. Life Outcomes 11(1), (2013)

Lang, H.C., Chuang, L., Shun, S.C., Hsieh, C.L., Lan, C.F.: Validation of EQ-5D in patients with cervical cancer in Taiwan. Support Care Cancer 18(10), 1279–1286 (2010)CrossRefPubMed

Janssen, M.F., Lubetkin, E.I., Sekhobo, J.P., Pickard, A.S.: The use of the EQ-5D preference-based health status measure in adults with Type 2 diabetes mellitus. Diabet. Med. 28(4), 395–413 (2011)CrossRefPubMed

Aburuz, S., Bulatova, N., Twalbeh, M., Gazawi, M.: The validity and reliability of the Arabic version of the EQ-5D: a study from Jordan. Ann. Saudi Med. 29(4), 304–308 (2009)CrossRefPubMedPubMedCentral

Kontodimopoulos, N., Pappa, E., Niakas, D., Yfantopoulos, J., Dimitrakaki, C., Tountas, Y.: Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. Value Health 11(7), 1162–1169 (2008)CrossRefPubMed

10.

Van De Willige, G., Wiersma, D., Nienhuis, F.J., Jenner, J.A.: Changes in quality of life in chronic psychiatric patients: a comparison between EuroQol (EQ-5D) and WHOQoL. Qual. Life Res. 14(2), 441–451 (2005). doi:10.1007/s11136-004-0689-y CrossRefPubMed

11.

Petrou, S., Hockley, C.: An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Econ. 14(11), 1169–1189 (2005)CrossRefPubMed

12.

Petrou, S., Morrell, J., Spiby, H.: Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context. Health Qual. Life Outcomes 7(1), 40 (2009)CrossRefPubMedPubMedCentral

13.

Bharmal, M., Thomas 3rd, J.: Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value health J. Int. Soc. Pharmacoeconomics Outcomes Res. 9(4), 262–271 (2006). doi:10.1111/j.1524-4733.2006.00108.x CrossRef

14.

Brazier, J., Roberts, J., Tsuchiya, A., Busschbach, J.: A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 13(9), 873–884 (2004). doi:10.1002/hec.866 CrossRefPubMed

15.

Janssen, M.F., Birnie, E., Haagsma, J.A., Bonsel, G.J.: Comparing the Standard EQ-5D three-level system with a five-level version. Value Health 11(2), 275–284 (2008)CrossRefPubMed

16.

Kim, S.H., Kim, H.J., Lee, S.I., Jo, M.W.: Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Qual. Life Res. 21(6), 1065–1073 (2012)CrossRefPubMed

17.

Janssen, M.F., Pickard, A.S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., Swinburn, P., Busschbach, J.: Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual. Life Res. 22(7), 1717–1727 (2013). doi:10.1007/s11136-012-0322-4 CrossRefPubMed

18.

Pickard, A.S., Kohlmann, T., Janssen, M.F., Bonsel, G., Rosenbloom, S., Cella, D.: Evaluating equivalency between response systems: application of the Rasch model to a 3-level and 5-level EQ-5D. Med. Care. 45(9), 812–819 (2007)CrossRefPubMed

19.

Janssen, M.F., Birnie, E., Bonsel, G.J.: Quantification of the level descriptors for the standard EQ-5D three-level system and a five-level version according to two methods. Qual life Res.Int. J. Qual. Life Asp. Treat. care Rehabil. 17(3), 463–473 (2008). doi:10.1007/s11136-008-9318-5 CrossRef

20.

Luo, N., Li, M., Chevalier, J., Lloyd, A., Herdman, M.: A comparison of the scaling properties of the English, Spanish, French, and Chinese EQ-5D descriptive systems. Qual Life Res., 1–7 (2012). doi:10.1007/s11136-012-0342-0

21.

Kim, T.H., Jo, M.W., Lee, S.i., Kim, S.H., Chung, S.M.: Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual Life Res., 22(8):2245–2253 (2013)

22.

Pickard, A.S., De Leon, M.C., Kohlmann, T., Cella, D., Rosenbloom, S.: Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med. Care 45(3), 259–263 (2007)CrossRefPubMed

23.

Scalone, L., Ciampichini, R., Fagiuoli, S., Gardini, I., Fusco, F., Gaeta, L., Del Prete, A., Cesana, G., Mantovani, L.G.: Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases. Qual. Life Res. 22(7), 1707–1716 (2013)CrossRefPubMed

24.

Errea, M.: Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations. In: Departamento de Economía-Universidad Pública de Navarra, (2013)

25.

Herdman, M., Gudex, C., Lloyd, A., Janssen, M.F., Kind, P., Parkin, D., Bonsel, G., Badia, X.: Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual. Life Res. 20(10), 1727–1736 (2011). doi:10.1007/s11136-011-9903-x CrossRefPubMedPubMedCentral

26.

Tadros, A., Vergou, T., Stratigos, A.J., Tzavara, C., Hletsos, M., Katsambas, A., Antoniou, C.: Psoriasis: is it the tip of the iceberg for the quality of life of patients and their families? J. Eur. Acad. Dermatol. Venereol. 25(11), 1282–1287 (2011)CrossRefPubMed

27.

Rabin, R., de Charro, F.: EQ-5D: a measure of health status from the EuroQol Group. Ann. Med. 33(5), 337–343 (2001)CrossRefPubMed

28.

Bhosle, M.J., Kulkarni, A., Feldman, S.R., Balkrishnan, R.: Quality of life in patients with psoriasis. Health Qual. Life Outcomes 4, 35 (2006). doi:10.1186/1477-7525-4-35 CrossRefPubMedPubMedCentral

29.

Dolan, P., Gudex, C., Kind, P., Williams, A.: A social tariff for EuroQol: results from a UK general population survey. Cent. Health Econ., (1995)

30.

Brooks, R.: The EuroQol group after 25 years. Springer, Dordrecht (2012)

31.

EuroQol: EQ-5D-5L index value calculator. version 1.0. http://www.euroqol.org/about-eq-5d/valuation-of-eq-5d/eq-5d-5l-value-sets.html (2013). Accessed 10 Μαίου 2013

32.

Van Hout, B., Janssen, M.F., Feng, Y.S., Kohlmann, T., Busschbach, J., Golicki, D., Lloyd, A., Scalone, L., Kind, P., Pickard, A.S.: Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health 15(5), 708–715 (2012). doi:10.1016/j.jval.2012.02.008 CrossRefPubMed

33.

Brooks, R., EuroQol Group: EuroQol: the current state of play. Health Policy 37(1), 53–72 (1996)CrossRef

34.

Brooks, R.G.: 28 Years of the EuroQol Group: an overview. EuroQol Working Paper Series. (2015)

35.

Yfantopoulos, J.: The Greek version of the EuroQol (EQ-5D) instrument. Arch. Hell. Med. 18(2), 180–191 (2001)

36.

Terwee, C.B., Bot, S.D., de Boer, M.R., van der Windt, D.A., Knol, D.L., Dekker, J., Bouter, L.M., de Vet, H.C.: Quality criteria were proposed for measurement properties of health status questionnaires. J. Clin. Epidemiol. 60(1), 34–42 (2007)CrossRefPubMed

37.

Bland, Martin: J., Altman, D.: statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327(8476), 307–310 (1986)CrossRef

38.

Whitehurst, D.G.T., Bryan, S., Lewis, M.: Systematic review and empirical comparison of contemporaneous EQ-5D and SF-6D group mean scores. Med. Decis. Mak. 31(6), E34–E44 (2011). doi:10.1177/0272989X11421529 CrossRef

39.

Janssen, M.F.B., Birnie, E., Bonsel, G.J.: Evaluating the discriminatory power of EQ-5D, HUI2 and HUI3 in a US general population survey using Shannon’s indices. Qual. Life Res. 16(5), 895–904 (2007)CrossRefPubMedCentral

40.

Lloyd, M., Ghelardi, R.J.: A table for calculating theEquitability’Component of species diversity. J. Anim. Ecol., 217–225 (1964)

41.

Heip, C.H., Herman, P.M., Soetaert, K.: Indices of diversity and evenness. Oceanis 24(4), 61–88 (1998)

42.

Barton, G.R., Sach, T.H., Avery, A.J., Jenkinson, C., Doherty, M., Whynes, D.K., Muir, K.R.: A comparison of the performance of the EQ-5D and SF-6D for individuals aged ≥ 45 years. Health Econ. 17(7), 815–832 (2008). doi:10.1002/hec.1298 CrossRefPubMed

43.

Deng, N., Allison, J.J., Fang, H.J., Ash, A.S., Ware Jr, J.E.: Using the bootstrap to establish statistical significance for relative validity comparisons among patient-reported outcome measures. Health Qual. Life Outcomes 11, 89 (2013). doi:10.1186/1477-7525-11-89 CrossRefPubMedPubMedCentral

44.

Pickard, A.S., Ray, S., Ganguli, A., Cella, D.: Comparison of FACT- and EQ-5D-based utility scores in cancer. Value Health 15(2), 305–311 (2012). doi:10.1016/j.jval.2011.11.029 CrossRefPubMed

45.

Wilke, C.T., Pickard, A.S., Walton, S.M., Moock, J., Kohlmann, T., Lee, T.A.: Statistical implications of utility weighted and equally weighted HRQL measures: an empirical study. Health Econ. 19(1), 101–110 (2010)PubMed

46.

Hays, R., Anderson, R., Revicki, D.: Psychometric considerations in evaluating health-related quality of life measures. Qual. Life Res. 2(6), 441–449 (1993)CrossRefPubMed

47.

Luo, N., Johnson, J.A., Shaw, J.W., Coons, S.J.: Relative efficiency of the EQ-5D, HUI2, and HUI3 index scores in measuring health burden of chronic medical conditions in a population health survey in the USA. Med. Care 47(1), 53–60 (2009). doi:10.1097/MLR.0b013e31817d92f8 CrossRefPubMed

48.

Huang, I.C., Willke, R.J., Atkinson, M.J., Lenderking, W.R., Frangakis, C., Wu, A.W.: US and UK versions of the EQ-5D preference weights: does choice of preference weights make a difference? Qual. Life Res. 16(6), 1065–1072 (2007)CrossRefPubMed

49.

Cunillera, O., Tresserras, R., Rajmil, L., Vilagut, G., Brugulat, P., Herdman, M., Mompart, A., Medina, A., Pardo, Y., Alonso, J.: Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey. Qual. Life Res. 19(6), 853–864 (2010)CrossRefPubMed

50.

Nosyk, B., Sun, H., Guh, D.P., Oviedo-Joekes, E., Marsh, D.C., Brissette, S., Schechter, M.T., Anis, A.H.: The quality of eight health status measures were compared for chronic opioid dependence. J. Clin. Epidemiol. 63(10), 1132–1144 (2010)CrossRefPubMed

51.

Zhao, F.L., Yue, M., Yang, H., Wang, T., Wu, J.H., Li, S.C.: Validation and comparison of euroqol and short form 6D in chronic prostatitis patients. Value Health 13(5), 649–656 (2010)CrossRefPubMed

52.

García-Gordillo, M.A., del Pozo-Cruz, B., Adsuar, J.C., Sánchez-Martínez, F.I., Abellán-Perpiñán, J.M.: Validation and comparison of 15-D and EQ-5D-5L instruments in a Spanish Parkinson’s disease population sample. Qual. Life Res., 1–12 (2013). doi:10.1007/s11136-013-0569-4

53.

DeLong, E.R., DeLong, D.M., Clarke-Pearson, D.L.: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3), 837–845 (1988)CrossRefPubMed

54.

Pan, C.W., Sun, H.P., Wang, X., Ma, Q., Xu, Y., Luo, N., Wang, P.: The EQ-5D-5L index score is more discriminative than the EQ-5D-3L index score in diabetes patients. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation 24(7), 1767–1774 (2015). doi:10.1007/s11136-014-0902-6 CrossRef

Title: Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece
Authors: John N. Yfantopoulos
Athanasios E. Chantzaras
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: The European Journal of Health Economics / Issue 4/2017
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI: https://doi.org/10.1007/s10198-016-0807-0

At a glance: The STEP trials

Springer Medicine

Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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