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

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Abstract

Background

Since the introduction of the five-level version of the EQ-5D (5L), many studies have comparatively investigated the measurement properties of the original three-level version (3L) with the 5L version.

Objective

The aim of this study was to consolidate the available evidence on the performance of both instruments.

Methods

A systematic literature search of studies in the English and German languages was conducted (2007–January 2018) using the PubMed, EMBASE, and PsycINFO (EBSCO) databases, as well as the EuroQol Research Foundation website. Data were extracted and assessed on missing values, distributional properties, informativity indices (Shannon’s H′ and J′), inconsistencies, responsiveness, and test–retest reliability.

Results

Twenty-four studies were included in the review. Missing values and floor effects (percentage reporting the worst health state) were found to be negligible for both 3L and 5L (< 5%). From 18 studies, inconsistencies ranged from 0 to 10.6%, although they were generally well below 5%, with 9 studies reporting the most inconsistencies for Usual Activities (mean percentage 4.1%). Shannon’s indices were always higher for 5L than for 3L, and all but three studies reported lower ceiling effects (‘11111’) for 5L than for 3L. There is mixed and insufficient evidence on responsiveness and test–retest reliability, although results on index values showed better performance for 5L on test–retest reliability.

Conclusion

Overall, studies showed similar or better measurement properties of the 5L compared with the 3L, and evidence indicated moderately better distributional parameters and substantial improvement in informativity for the 5L compared with the 3L. Insufficient evidence on responsiveness and test–retest reliability implies further research is needed.

Electronic supplementary material

The online version of this article (10.1007/s40273-018-0642-5) contains supplementary material, which is available to authorized users.

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Most cited references 31

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Method agreement analysis: a review of correct methodology.

P.F. Watson, A Petrie (2010)

The correct approach to analyzing method agreement is discussed. Whether we are considering agreement between two measurements on the same samples (repeatability) or two individuals using identical methodology on identical samples (reproducibility) or comparing two methods, appropriate procedures are described, and worked examples are shown. The correct approaches for both categorical and numerical variables are explained. More complex analyses involving a comparison of more than two pairs of data are mentioned and guidance for these analyses given. Simple formulae for calculating the approximate sample size needed for agreement analysis are also given. Examples of good practice from the reproduction literature are cited, and common errors of methodology are indicated. 2010 Elsevier Inc. All rights reserved.

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Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study

Ulrike Ravens-Sieberer, Nora Wille, Xavier Badia … (2010)

Purpose To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y. Methods The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test–retest reliability was determined. Spearman’s rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups’ validity was examined by comparing groups with a priori expected differences in HRQOL. Results Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1–24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8–47.3%) and Italy (4.3–39.0%). Percentages of agreement in test–retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = −0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups’ validity. Conclusions Results provide preliminary evidence of the instrument’s feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses.

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A review of health utilities using the EQ-5D in studies of cardiovascular disease

Matthew TD Dyer, Kimberley A. Goldsmith, Linda Sharples … (2010)

Background The EQ-5D has been extensively used to assess patient utility in trials of new treatments within the cardiovascular field. The aims of this study were to review evidence of the validity and reliability of the EQ-5D, and to summarise utility scores based on the use of the EQ-5D in clinical trials and in studies of patients with cardiovascular disease. Methods A structured literature search was conducted using keywords related to cardiovascular disease and EQ-5D. Original research studies of patients with cardiovascular disease that reported EQ-5D results and its measurement properties were included. Results Of 147 identified papers, 66 met the selection criteria, with 10 studies reporting evidence on validity or reliability and 60 reporting EQ-5D responses (VAS or self-classification). Mean EQ-5D index-based scores ranged from 0.24 (SD 0.39) to 0.90 (SD 0.16), while VAS scores ranged from 37 (SD 21) to 89 (no SD reported). Stratification of EQ-5D index scores by disease severity revealed that scores decreased from a mean of 0.78 (SD 0.18) to 0.51 (SD 0.21) for mild to severe disease in heart failure patients and from 0.80 (SD 0.05) to 0.45 (SD 0.22) for mild to severe disease in angina patients. Conclusions The published evidence generally supports the validity and reliability of the EQ-5D as an outcome measure within the cardiovascular area. This review provides utility estimates across a range of cardiovascular subgroups and treatments that may be useful for future modelling of utilities and QALYs in economic evaluations within the cardiovascular area.

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Author and article information

Contributors

Ines Buchholz:

ORCID: http://orcid.org/0000-0001-9729-6992

+49 (0)3834/86-7780 , ines.buchholz@uni-greifswald.de

Journal

Journal ID (nlm-ta): Pharmacoeconomics

Journal ID (iso-abbrev): Pharmacoeconomics

Title: Pharmacoeconomics

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1170-7690

ISSN (Electronic): 1179-2027

Publication date (Electronic): 23 March 2018

Publication date PMC-release: 23 March 2018

Publication date (Print): 2018

Volume: 36

Issue: 6

Pages: 645-661

Affiliations

[1 ]GRID grid.5603.0, Institute for Community Medicine, University Medicine of Greifswald, ; Greifswald, Germany

[2 ]ISNI 000000040459992X, GRID grid.5645.2, Department of Medical Psychology and Psychotherapy, , Erasmus MC, ; Rotterdam, The Netherlands

Author information

Ines Buchholz http://orcid.org/0000-0001-9729-6992

Article

Publisher ID: 642

DOI: 10.1007/s40273-018-0642-5

PMC ID: 5954044

PubMed ID: 29572719

SO-VID: 1a1c59b8-41e5-4ea9-9ee2-a49eb0dc667f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100006419, EuroQol Research Foundation;

Award ID: EQ Project 2016170

Award Recipient : Ines Buchholz

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

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Most cited references 31

Method agreement analysis: a review of correct methodology.

Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study

A review of health utilities using the EQ-5D in studies of cardiovascular disease

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