The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L

Konnopka, Alexander; König, Hans‐Helmut

doi:10.1007/s11136-017-1551-3

Cited by 26 publications

(17 citation statements)

References 10 publications

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“…For instance, even among a random sample of Japanese adults, QoL scores are lower for individuals over the age of 60 [36]. In addition, Konnopka and Koeing [12] observed significant associations between age and the EQ-5D-5L dimensions of "morbidity" and "self-care." In terms of living alone, one study analyzed the associations between living arrangement and HRQoL, revealing that HRQoL among older adults living alone or with adult children was worse than those living with a spouse in an urban area [37].…”

Section: Discussionmentioning

confidence: 99%

“…Although one report suggests that 63.2% of studies published in the Web of Science (2004-2010) using a generic preference-based measure have included the EQ-5D [9,10], it is well known that the EQ-5D-3L produces a ceiling effect (CE) [5,7,11]. This indicates a range-of-instrument constraint [12]. For this reason, the EQ-5D-5 Level (5L) was established to improve sensitivity and reduce CE.…”

Section: Introductionmentioning

confidence: 99%

“…While the 5L exhibits a lower CE than the 3L, there are still reports of a CE using the 5L within general population samples [11,12]. For instance, Konnopka and Koening [12] used the term "no-problems-problem" in a study that analyzed the association between CE and morbidity. As the EQ-5D was never intended to cover all dimensions of health due to a five-dimensional structure, there are some health problems that cannot be captured.…”

Section: Introductionmentioning

confidence: 99%

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Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged “no-problems”

et al. 2019

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Purpose The goal of the present study was to determine factors related to a ceiling effect (CE) on the EQ-5D-5L among Japanese patients with prostate cancer (PC). Methods An existent cross-sectional observational study dataset was used. Patients were ≥ 20 years of age and diagnosed with PC. For CE determinants on the EQ-5D-5L, we excluded possible "full-health" patients flagged by the EQ-VAS (score = 100) and/or FACT-P (score = 156) instruments. We then divided them into binary variables: A CE group (EQ-5D-5L score = 1) and others (< 1). The associations between CE, sociodemographic and medical characteristics, and FACT-P subscale scores were examined using a multivariate LASSO selection followed by a binomial logistic regression analysis performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results A total of 362 patients were analyzed. The LASSO selection variables, including all obtained variables, were as follows: age, palliative treatment, FACT-P physical well-being, and PC subscale score. Statistically significant variables predicting CE were palliative treatment (OR 0.23; 95% CI 0.09-0.60), physical well-being (OR 1.54; 95% CI 1.34-1.76), and PC subscale (OR 1.08; 95% CI 1.03-1.14). Conclusions This study revealed that palliative treatment and two FACT-P physical well-being and PC subscale scores were positively related to CE on the EQ-5D-5L. To our knowledge, this is the first study to examine predictors of CE on the EQ-5D-5L. The present results may be helpful for facilitating the consideration of "bolt-on" studies from the standpoint of PC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged “no-problems”

et al. 2019

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“…Therefore, there may have been a ceiling effect in a large proportion of the study population which prevented us from finding improvements in QALY scores . As was suggested in previous research, the Euroqol‐5D‐5 L may not have the discriminative power to detect changes in a healthy population . Changes in health‐related quality of life have been detected within 1 year in studies using alternative measures such as positive affect, craving and frequency of stressful events .…”

Section: Discussionmentioning

confidence: 95%

Cost‐effectiveness and cost–utility analysis of a work‐place smoking cessation intervention with and without financial incentives

et al. 2019

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Aims To perform an economic evaluation of a work‐place smoking cessation group training programme with incentives compared with a training programme without incentives. Design A trial‐based cost‐effectiveness analysis (CEA) and cost–utility analysis (CUA) from a societal perspective and an employer's perspective. Setting Sixty‐one companies in the Netherlands. Participants A total of 604 tobacco‐smoking employees. Intervention and comparator A 7‐week work‐place smoking cessation group training programme. The intervention group earned gift vouchers of €350 for 12 months’ continuous abstinence. The comparator group received no incentives. Measurements Online questionnaires were administered to assess quality of life (EQ‐5D‐5 L) and resource use during the 14‐month follow‐up period (2‐month training period plus 12‐month abstinence period). For the CEA the primary outcome measure was carbon monoxide (CO)‐validated continuous abstinence; for the CUA the primary outcome was quality‐adjusted life years (QALY). Bootstrapping and sensitivity analyses were performed to account for uncertainty. Incremental cost‐effectiveness ratio (ICER) tables were used to determine cost‐effectiveness from a life‐time perspective. Findings Of the participants in the intervention group, 41.1% had quit smoking compared with 26.4% in the control group. From a societal perspective with a 14‐month follow‐up period, the ICER per quitter for an intervention with financial incentives compared with no incentives was €11 546. From an employer's perspective, the ICER was €5686. There was no significant difference in QALYs between the intervention and control group within the 14‐month follow‐up period. The intervention was dominated by the comparator in the primary analysis at a threshold of €20 000 per QALY. In the sensitivity analysis, these results were uncertain. A life‐time perspective showed an ICER of €1249 (95% confidence interval = €850–2387) per QALY. Conclusions Financial incentives may be cost‐effective in increasing quitting smoking, particularly from a life‐time perspective.

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“…The EQ-5D-5L has replaced the previous version EQ-5D-3L that had only three response options, hoping to decrease the considerable ceiling effects. These are still found for the 5L version in the general population, but less so in people with increased morbidity [19,20].…”

Section: Introductionmentioning

confidence: 91%

How to measure fluctuating impairments in people with MS: development of an ambulatory assessment version of the EQ-5D-5L in an exploratory study

et al. 2021

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Background Health fluctuations even within a single day are typical in multiple sclerosis (MS), but are not captured by widely used questionnaires like the EQ-5D-5L. This exploratory study aimed to develop an ambulatory assessment (AA) version of the EQ-5D-5L (EQ-5D-AA) where patients rate their health on mobile phones multiple times per day over several days, and to assess its feasibility and face validity. Methods An initial EQ-5D-AA version was based on two patient focus groups. It was then tested and continuously developed in an iterative process: patients completed it over several days, followed by debriefing interviews. Findings were used to refine the EQ-5D-AA, with the resulting version being tested by the subsequent wave of patients until participants declared no need for changes anymore. Before and after the AA period, participants completed the standard paper-based EQ-5D-5L asking about ‘today’. Results Focus group participants reported that their impairments often fluctuated between and within days. They regarded an AA with three assessments per day over seven days most appropriate; assessment should be retrospective to the previous assessment, but not all items should be assessed at each time point. Four waves of AA testing were conducted. Thirteen out of the 17 participants preferred the AA over standard assessment as they regarded it more informative, but not too burdensome. Conclusion The newly developed one-week AA of the EQ-5D-5L captures within-day and day-to-day health fluctuations in people with MS. From the patients’ perspective, it is a feasible and face valid way to provide important information beyond what is captured by the standard EQ-5D-5L.

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The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L

Abstract: When analyzing ceiling effects of the EQ-5D 5L, one has to draw attention to morbidity since high proportions of participants indicating the best health state might result from being healthy regarding the dimensions assessed by the EQ-5D, in particular in general population datasets.

Cited by 26 publications

References 10 publications

Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged “no-problems”

Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged “no-problems”

Cost‐effectiveness and cost–utility analysis of a work‐place smoking cessation intervention with and without financial incentives

How to measure fluctuating impairments in people with MS: development of an ambulatory assessment version of the EQ-5D-5L in an exploratory study

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