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

Buchholz, Ines; Janssen, Mathieu F.; Kohlmann, Thomas; Feng, You-Shan

doi:10.1007/s40273-018-0642-5

Cited by 227 publications

(242 citation statements)

References 63 publications

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“…We also examined the informational characteristics of the competing descriptive systems by using measures frequently reported in the literature, such as Shannon's absolute and relative measures of informativity. Our findings were similar to the summaries reported by Buchholz et al [3], with zero or modest improvements in relative informativity in the general population but gains in absolute informativity across all domains. However, for a multimorbid population, there was an improvement in both absolute and relative measures of informativity across most domains.…”

Section: Discussionsupporting

confidence: 91%

“…A key problem for the EQ-5D-3L is its tendency to generate significant 'ceiling effects' whereby a high proportion of respondents report having 'no problems' on all or one domain [3]. In line with previous studies using general population samples, we found a 10.6 percentage point fall in full health (no problems on all domains) reported for the EQ-5D-5L versus the EQ-5D-3L [5,20,21].…”

Section: Discussionsupporting

confidence: 88%

“…We used Shannon's indices to examine the relative discriminatory power of the 3L and 5L [3]. These indices are derived from informational theory and assume that a measure provides the most information if responses are distributed equally across all response categories.…”

Section: Informativitymentioning

confidence: 99%

“…A recent systematic review of studies comparing the performance of EQ-5D-5L and EQ-5D-3L found the EQ-5D-5L to have either similar or better measurement properties than the EQ-5D-3L [3]. Importantly, there was evidence of reduced ceiling effects with the EQ-5D-5L and also a better spread of respondents using all levels within each domain.…”

Section: Introductionmentioning

confidence: 99%

“…By reducing the clustering around full health and improving the distribution of respondents across levels, the EQ-5D-5L has potentially greater scope to capture smaller changes in health status. The majority of previous studies have been 'head-tohead' (H2H) comparisons using responses for both measures completed by the same individuals [3]. There is also a subset of 'indirect' studies [4,5] that compare responses using different individuals, potentially allowing for a much larger sample size; however, a key challenge for previous indirect studies are that respondents have been different on observable characteristics, potentially biasing any findings.…”

Section: Introductionmentioning

confidence: 99%

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A Comparison of the EQ-5D-3L and EQ-5D-5L

Thompson

Turner

2020

PharmacoEconomics

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Introduction The EQ-5D-3L (3L) and EQ-5D-5L (5L) are both frequently used measures of health status. Previous studies have found the EQ-5D-5L to have superior measurement properties but no study has compared the two measures in a large general population survey using matched respondents. Methods Using data from the GP Patient Survey, coarsened exact matching was used to match individuals completing the 3L in 2011 with those completing the 5L in 2012. Measurement properties were assessed for a general population and multimorbid population (chronic conditions ≥ 2), with ceiling effects, informativity and distribution of response compared. Changes in the direction of response, as well as the impact on utility distributions, were quantified. Results Matching resulted in a cohort of 1, 023,218 respondents (2011: 511,609; 2012: 511,609) for analysis. Ceiling effects for the 5L were lower than the 3L (43.8% vs. 54.4%). The 5L had improved informativity and broader spread of responses than the 3L (5L top 50 profiles: 77.4% vs. 3L: 98.8%). Overall, there was an upwards shift in utility values for the 5L versus the 3L as respondents using the 5L reported ill health more frequently but with less severity. Measurement improvements and effects on utility values were more pronounced for the multimorbid population. Conclusion The 5L had superior measurement properties than the 3L and should be preferred in general population surveys and for use in individuals with multimorbidity. At increasing levels of morbidity, the 5L is currently associated with higher utility values than the 3L. Electronic supplementary material The online version of this article (https ://doi.The EQ-5D-5L has superior measurement properties to the EQ-5D-3L and should be preferred in general population and multimorbid populations.The EQ-5D-5L leads respondents to report more illhealth. However, it is less severe than when using the EQ-5D-3L.For higher-levels of multimorbidity, use of the EQ-5D-5L in England will currently lead to higher utility values than the EQ-5D-3L, irrespective of the tariff used.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Section: Informativitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Comparison of the EQ-5D-3L and EQ-5D-5L

Thompson

Turner

2020

PharmacoEconomics

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Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management

Partyka,

Asha,

Berry

et al. 2024

JAMA Surg

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ImportanceRib fractures secondary to blunt thoracic trauma typically result in severe pain that is notoriously difficult to manage. The serratus anterior plane block (SAPB) is a regional anesthesia technique that provides analgesia to most of the hemithorax; however, SAPB has limited evidence for analgesic benefits in rib fractures.ObjectiveTo determine whether the addition of an SAPB to protocolized care bundles increases the likelihood of early favorable analgesic outcomes and reduces opioid requirements in patients with rib fractures.Design, Setting, and ParticipantsThis multicenter, open-label, pragmatic randomized clinical trial was conducted at 8 emergency departments across metropolitan and regional New South Wales, Australia, between April 12, 2021, and January 22, 2022. Patients aged 16 years or older with clinically suspected or radiologically proven rib fractures were included in the study. Participants were excluded if they were intubated, transferred for urgent surgical intervention, or had a major concomitant nonthoracic injury. Data were analyzed from September 2022 to July 2023.InterventionsPatients were randomly assigned (1:1) to receive an SAPB in addition to usual rib fracture management or standard care alone.Main Outcomes and MeasuresThe primary outcome was a composite pain score measured 4 hours after enrollment. Patients met the primary outcome if they had a pain score reduction of 2 or more points and an absolute pain score of less than 4 out of 10 points.ResultsA total of 588 patients were screened, of whom 210 patients (median [IQR] age, 71 [55-84] years; 131 [62%] male) were enrolled, with 105 patients randomized to receive an SAPB plus standard care and 105 patients randomized to standard care alone. In the complete-case intention-to-treat primary outcome analysis, the composite pain score outcome was reached in 38 of 92 patients (41%) in the SAPB group and 18 of 92 patients (19.6%) in the control group (relative risk [RR], 0.73; 95% CI, 0.60-0.89; P = .001). There was a clinically significant reduction in overall opioid consumption in the SAPB group compared with the control group (eg, median [IQR] total opioid requirement at 24 hours: 45 [19-118] vs 91 [34-155] milligram morphine equivalents). Rates of pneumonia (6 patients [10%] vs 7 patients [11%]), length of stay (eg, median [IQR] hospital stay, 4.2 [2.2-7.7] vs 5 [3-7.3] days), and 30-day mortality (1 patient [1%] vs 3 patients [4%]) were similar between the SAPB and control groups.Conclusions and RelevanceThis randomized clinical trial found that the addition of an SAPB to standard rib fracture care significantly increased the proportion of patients who experienced a meaningful reduction in their pain score while also reducing in-hospital opioid requirements.Trial Registrationhttp://anzctr.org.au Identifier: ACTRN12621000040864

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