Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adults

Abstract

BackgroundSome studies have reported a ceiling effect in EQ-5D-3L, especially in healthy and/or young individuals. Recently, two further levels have been included in its measurement model (EQ-5D-5L). The purposes of this study were (1) to assess the properties of the EQ-5D-5L in comparison with the standard EQ-5D-3L in a sample of young adults, (2) to foreground the importance of collecting qualitative data to confirm, validate or refine the EQ-5D questionnaire items and (3) to raise questions pertaining to the wording in these questionnaire items.MethodsThe data used came from a sample of respondents aged 30 or under (n = 624). They completed both versions of the EQ-5D, which were compared in terms of feasibility, level of inconsistency and ceiling effect. Agreement between the instruments was assessed using correlation coefficients and Bland-Altman plots. Known-groups validity of the EQ-5D-5L was also assessed using non-parametric tests. The discriminative properties were compared using receiver operating characteristic curves. Finally, four interviews were conducted for retrospective reports to elicit respondents’ understanding and perceptions of the format, instructions, items, and responses.ResultsQuantitative results show a ceiling effect reduction of 25.3 % and a high level agreement between both indices. Known-groups validity was confirmed for the EQ-5D-5L. Explorative interviews indicated ambiguity and low degree of certainty in regards to conceptualizing differences between levels moderate-slight across three dimensions.ConclusionsThe EQ-5D-5L performed better than the EQ-5D-3L. However, the explorative interviews demonstrated several limitations in the EQ-5D questionnaire wording and high context-dependent answers point to lack of illnesses’ experience amongst young adults.

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“…49 Several studies have compared the EQ-5D-3L and the EQ-5D-5L in different countries in both general population samples and specific patient groups, but none of these has examined the two measures in critical care patients. [49][50][51][52][53][54][55][56][57][58][59] The aim of the present study was to compare EQ-5D-3L scores with EQ-5D-5L scores in critical care survivors in the UK. The sample for the present study comprised 359 patients treated at any of the 20 participating UK centres.…”

“…There have been several studies comparing the EQ-5D-5L and EQ-5D-3L in different populations, generally showing that the EQ-5D-5L performs better than the EQ-5D-3L as a result of reduction in ceiling effects [49][50][51][53][54][55][57][58][59] and ability to discriminate between patient characteristics. [52][53][54]56,57 Some studies have shown a high level of agreement between the two measures.…”

“…[52][53][54]56,57 Some studies have shown a high level of agreement between the two measures. 50,51,54,57,59 There have been no studies comparing the two instruments in critical care survivors.…”

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“…The values will be situated on a scale that ranges between zero and one, or death and full health. Negative values may be assumed for health states considered worse than death (Drummond et al, 2005;Ferreira, 2010;Ferreira et al, 2013a). The Portuguese version of the EQ-5D was completed in 1998 and published in 2013, by Ferreira and his collaborators (Ferreira et al, 2013a).…”

“…Negative values may be assumed for health states considered worse than death (Drummond et al, 2005;Ferreira, 2010;Ferreira et al, 2013a). The Portuguese version of the EQ-5D was completed in 1998 and published in 2013, by Ferreira and his collaborators (Ferreira et al, 2013a). The SF-6D was developed from the SF-36 instrument and has six dimensions (physical functioning, role limitation, social functioning, pain, mental health and vitality), each with four to six levels, allowing the generation of 18.000 distinct health states (Brazier et al, 2002).…”