Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
PharmacoEconomics
Published in: PharmacoEconomics 6/2018

Open Access 01-06-2018 | Original Research Article

Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries

Authors: Mathieu F. Janssen, Gouke J. Bonsel, Nan Luo

Published in: PharmacoEconomics | Issue 6/2018

Login to get access

Abstract

Objective

This study describes the first empirical head-to-head comparison of EQ-5D-3L (3L) and EQ-5D-5L (5L) value sets for multiple countries.

Methods

A large multinational dataset, including 3L and 5L data for eight patient groups and a student cohort, was used to compare 3L versus 5L value sets for Canada, China, England/UK (5L/3L, respectively), Japan, The Netherlands, South Korea and Spain. We used distributional analyses and two methods exploring discriminatory power: relative efficiency as assessed by the F statistic, and an area under the curve for the receiver-operating characteristics approach. Differences in outcomes were explored by separating descriptive system effects from valuation effects, and by exploring distributional location effects.

Results

In terms of distributional evenness, efficiency of scale use and the face validity of the resulting distributions, 5L was superior, leading to an increase in sensitivity and precision in health status measurement. When compared with 5L, 3L systematically overestimated health problems and consequently underestimated utilities. This led to bias, i.e. over- or underestimations of discriminatory power.

Conclusion

We conclude that 5L provides more precise measurement at individual and group levels, both in terms of descriptive system data and utilities. The increased sensitivity and precision of 5L is likely to be generalisable to longitudinal studies, such as in intervention designs. Hence, we recommend the use of the 5L across applications, including economic evaluation, clinical and public health studies. The evaluative framework proved to be useful in assessing preference-based instruments and might be useful for future work in the development of descriptive systems or health classifications.
Appendix
Available only for authorised users
Footnotes
1
We use the notation ‘3L-5L’ to refer to ‘3L compared to 5L’, ‘3L versus 5L’ or ‘3L and 5L’, depending on the context.
 
Literature
1.
The EuroQol Group. EuroQol–a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef
2.
3.
4.
5.
Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, Devlin N, et al. Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual Life Res. 2010;19(6):875–86.CrossRefPubMedPubMedCentral
6.
Ravens-Sieberer U, Wille N, Badia X, Bonsel G, Burstrom K, Cavrini G, et al. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual Life Res. 2010;19(6):887–97.CrossRefPubMedPubMedCentral
7.
Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ. The effect of adding a cognitive dimension to the EuroQol multiattribute health-status classification system. J Clin Epidemiol. 1999;52(4):293–301.CrossRefPubMed
8.
Swinburn P, Lloyd A, Boye KS, Edson-Heredia E, Bowman L, Janssen B. Development of a disease-specific version of the EQ-5D-5L for use in patients suffering from psoriasis: lessons learned from a feasibility study in the UK. Value Health. 2013;16(8):1156–62.CrossRefPubMed
9.
Yang Y, Brazier J, Tsuchiya A. Effect of adding a sleep dimension to the EQ- 5D descriptive system: a “bolt-on” experiment. Med Decis Making. 2014;34(1):42–53.CrossRefPubMed
10.
Yang Y, Rowen D, Brazier J, Tsuchiya A, Young T, Longworth L. An exploratory study to test the impact on three “bolt-on” items to the EQ-5D. Value Health. 2015;18(1):52–60.CrossRefPubMedPubMedCentral
11.
Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.CrossRefPubMedPubMedCentral
12.
13.
Oppe M, Devlin NJ, van Hout B, Krabbe PF, de Charro F. A program of methodological research to arrive at the new international EQ-5D-5L valuation protocol. Value Health. 2014;17(4):445–53.CrossRefPubMed
14.
Ramos-Goñi JM, Oppe M, Slaap B, Busschbach JJ, Stolk E. Quality control process for EQ-5D-5L valuation studies. Value Health. 2017;20(3):466–73.CrossRefPubMed
15.
Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013;22(7):1717–27.CrossRefPubMed
16.
Jia YX, Cui FQ, Li L, Zhang DL, Zhang GM, Wang FZ, et al. Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B. Qual Life Res. 2014;23(8):2355–63.CrossRefPubMed
17.
Agborsangaya CB, Lahtinen M, Cooke T, Johnson JA. Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual Life Outcomes. 2014;12:74.CrossRefPubMedPubMedCentral
18.
Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Loucks L, Al KA, et al. Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Qual Life Res. 2015;24(7):1775–84.CrossRefPubMed
19.
Golicki D, Niewada M, Karlinska A, Buczek J, Kobayashi A, Janssen MF, et al. Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res. 2015;24(6):1555–63.CrossRefPubMed
20.
Greene ME, Rader KA, Garellick G, Malchau H, Freiberg AA, Rolfson O. The EQ-5D-5L improves on the EQ-5D-3L for health-related quality-of-life assessment in patients undergoing total hip arthroplasty. Clin Orthop Relat Res. 2015;473(11):3383–90.CrossRefPubMed
21.
Pan CW, Sun HP, 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. Qual Life Res. 2014;24(7):1767–74.CrossRefPubMed
22.
Pattanaphesaj J, Thavorncharoensap M. Measurement properties of the EQ-5D-5L compared to EQ-5D-3L in the Thai diabetes patients. Health Qual Life Outcomes. 2015;13:14.CrossRefPubMedPubMedCentral
23.
Richardson J, Iezzi A, Khan MA. Why do multi-attribute utility instruments produce different utilities: the relative importance of the descriptive systems, scale and ‘micro-utility’ effects. Qual Life Res. 2015;24(8):2045–53.CrossRefPubMedPubMedCentral
24.
van Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, et al. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health. 2012;15(5):708–15.CrossRefPubMed
25.
Xie F, Pullenayegum E, Gaebel K, Bansback N, Bryan S, Ohinmaa A, et al. A time trade-off-derived value set of the EQ-5D-5L for Canada. Med Care. 2016;54(1):98–105.CrossRefPubMed
26.
Bansback N, Tsuchiya A, Brazier J, Anis A. Canadian valuation of EQ-5D health states: preliminary value set and considerations for future valuation studies. PLoS One. 2012;7(2):e31115.CrossRefPubMedPubMedCentral
27.
Luo N, Liu G, Li M, Guan H, Jin X, Rand-Hendriksen K. Estimating an EQ-5D-5L value set for China. Value Health. 2017;20(4):662–9.CrossRefPubMed
28.
Liu GG, Wu H, Li M, Gao C, Luo N. Chinese time trade-off values for EQ-5D health states. Value Health. 2014;17(5):597–604.CrossRefPubMed
29.
30.
Shiroiwa T, Ikeda S, Noto S, Igarashi A, Fukuda T, Saito S, Shimozuma K. Comparison of value set based on DCE and/or TTO data: scoring for EQ-5D-5L health states in Japan. Value Health. 2016;19(5):648–54.CrossRefPubMed
31.
Tsuchiya A, Ikeda S, Ikegami N, et al. Estimating an EQ-5D population value set: the case of Japan. Health Econ. 2002;11(4):341–53.CrossRefPubMed
32.
Versteegh MM, Vermeulen KM, Evers SM, de Wit GA, Prenger R, Stolk EA. Dutch tariff for the five-level version of EQ-5D. Value Health. 2016;19(4):343–52.CrossRef
33.
Lamers LM, McDonnell J, Stalmeier PF, Krabbe PF, Busschbach JJ. The Dutch tariff: results and arguments for an effective design for national EQ-5D valuation studies. Health Econ. 2006;15(10):1121–32.CrossRefPubMed
34.
Kim SH, Ahn J, Ock M, Shin S, Park J, Luo N, et al. The EQ-5D-5L valuation study in Korea. Qual Life Res. 2016;25(7):1845–52.CrossRefPubMed
35.
Lee YK, Nam HS, Chuang LH, Kim KY, Yang HK, Kwon IS, et al. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value Health. 2009;12(8):1187–93.CrossRefPubMed
36.
Ramos-Goñi JM, Craig BM, Oppe M, Ramallo-Fariña Y, Pinto-Prades JL, Luo L, et al. Handling data quality issues to estimate the Spanish EQ-5D-5L value set using a hybrid interval regression approach. Value Health (In press).
37.
Badia X, Roset R, Herdman M, Kind P. A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. Med Decis Making. 2001;21(1):7–16.CrossRefPubMed
38.
Xie F, Gaebel K, Perampaladas K, Doble B, Pullenayegum E. Comparing EQ-5D valuation studies: a systematic review and methodological reporting checklist. Med Decis Making. 2014;34(1):8–20.CrossRefPubMed
39.
Oppe M, Rand-Hendriksen K, Shah K, Ramos-Goñi JM, Luo N. EuroQol protocols for time trade-off valuation of health outcomes. Pharmacoeconomics. 2016;34(10):993–1004.CrossRefPubMedPubMedCentral
40.
Parkin D, Devlin N, Feng Y. What determines the shape of an EQ-5D index distribution? Med Decis Making. 2016;36(8):941–51.CrossRefPubMed
41.
Janssen MF, Birnie E, Bonsel GJ. Evaluating the discriminatory power of EQ-5D, HUI2 and HUI3 in a US general population survey using Shannon’s indices. Qual Life Res. 2007;16(5):895–904.CrossRefPubMedCentral
42.
Vickrey BG, Hays RD, Genovese BJ, et al. Comparison of a generic to disease-targeted health-related quality-of-life measures for multiple sclerosis. J Clin Epidemiol. 1997;50:557–69.CrossRefPubMed
43.
Luo N, Johnson JA, Shaw JW, et al. 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 United States. Med Care. 2009;47:53–60.CrossRefPubMed
44.
Murray CJL, Özaltin E, Tandon A, Salomon JA, Sadana R, Chatterji SA. Empirical evaluation of the anchoring vignette approach in health surveys. In: Murray CJL, Evans DB, editors. Health system performance assessment: debates, methods and empiricism. Geneva: World Health Organization; 2003. p. 369–99.
45.
Lindeboom M, van Doorslaer E. Cut-point shift and index shift in self-reported health. J Health Econ. 2004;23(6):1083–99.CrossRefPubMed
46.
Rice N, Robone S, Smith P. Analysis of the validity of the vignette approach to correct for heterogeneity in reporting health system responsiveness. Eur J Health Econ. 2011;12(2):141–62.CrossRefPubMed
47.
Hirve S, Gómez-Olivé X, Oti S, Debpuur C, Juvekar S, Tollman S, et al. Use of anchoring vignettes to evaluate health reporting behavior amongst adults aged 50 years and above in Africa and Asia–testing assumptions. Glob Health Action. 2013;6(1):21064.CrossRefPubMed
48.
Valentine N, Verdes-Tennant E, Bonsel G. Health systems’ responsiveness and reporting behaviour: multilevel analysis of the influence of individual-level factors in 64 countries. Soc Sci Med. 2015;138:152–60.CrossRefPubMed
49.
Scalone L, Ciampichini R, Fagiuoli S, Gardini I, Fusco F, Gaeta L, et al. 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. 2013;22(7):1707–16.CrossRefPubMed
50.
51.
Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL, et al. Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments. BMC Med Res Methodol. 2006;6:2.CrossRefPubMedPubMedCentral
52.
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. International consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes: results of the COSMIN study. J Clin Epidemol. 2010;63:737–45.CrossRef
53.
Hernandez Alava M, Wailoo A, Grimm S, Pudney S, Gomes M, Sadique Z, et al. EQ-5D-5L versus EQ-5D-3L: the impact on cost-effectiveness. Value Health. 2018;21(1):49–56.CrossRefPubMed
54.
Huxley JS. Problems of relative growth. London: Methuen and Company Limited; 1932.
55.
56.
Fairclough DL. Design and analysis of quality of life studies in clinical trials. 2nd ed. New York: CRC Press; 2010.
57.
58.
Hilden J. Prevalence-free utility-respecting summary indices of diagnostic power do not exist. Stat Med. 2000;19(4):431–40.CrossRefPubMed
59.
Oppe M, Devlin N, Black N. Comparison of the underlying constructs of EQ-5D and Oxford Hip Score: implications for mapping. Value Health. 2011;14:884–91.CrossRefPubMed
Metadata
Title
Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries
Authors
Mathieu F. Janssen
Gouke J. Bonsel
Nan Luo
Publication date
01-06-2018
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 6/2018
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-018-0623-8

Other articles of this Issue 6/2018

PharmacoEconomics 6/2018 Go to the issue

Original Research Article

Head-to-Head Comparison of EQ‐5D‐3L and EQ‐5D‐5L Health Values

Systematic Review

A Systematic Review of Studies Comparing the Measurement Properties of the Three-Level and Five-Level Versions of the EQ-5D

Original Research Article

German Value Set for the EQ-5D-5L

Original Research Article

Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets

Commentary

Once Bitten Twice Shy: Thinking Carefully Before Adopting the EQ-5D-5L

Correction

Correction to: 3L, 5L, What the L? A NICE Conundrum