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15-09-2020 | Uitgave 3/2021

Quality of Life Research 3/2021

Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing

Quality of Life Research > Uitgave 3/2021
Juan Zhu, Xin-Xin Yan, Cheng-Cheng Liu, Hong Wang, Le Wang, Su-Mei Cao, Xian-Zhen Liao, Yun-Feng Xi, Yong Ji, Lin Lei, Hai-Fan Xiao, Hai-Jing Guan, Wen-Qiang Wei, Min Dai, Wanqing Chen, Ju-Fang Shi
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11136-020-02636-w) contains supplementary material, which is available to authorized users.
Juan Zhu and Xin-Xin Yan have contributed equally to this work.

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To compare the performance of three-level EuroQol five-dimensions (EQ-5D-3L) and five-level EuroQol five-dimensions (EQ-5D-5L) among common cancer patients in urban China.


A hospital-based cross-sectional survey was conducted in three provinces from 2016 to 2018 in urban China. Patients with breast cancer, colorectal cancer, or lung cancer were recruited to complete the EQ-5D-3L and EQ-5D-5L questionnaires. Response distribution, discriminatory power (indicator: Shannon index [H′] and Shannon evenness index [J′]), ceiling effect (the proportion of full health state), convergent validity, and health-related quality of life (HRQoL) were compared between the two instruments.


A total of 1802 cancer patients (breast cancer: 601, colorectal cancer: 601, lung cancer: 600) were included, with the mean age of 55.6 years. The average inconsistency rate was 4.4%. Compared with EQ-5D-3L (average: H′ = 1.100, J′ = 0.696), an improved discriminatory power was observed in EQ-5D-5L (H′ = 1.473, J′ = 0.932), especially contributing to anxiety/depression dimensions. The ceiling effect was diminished in EQ-5D-5L (26.5%) in comparison with EQ-5D-3L (34.5%) (p < 0.001), mainly reflected in the pain/discomfort and anxiety/depression dimensions. The overall utility score was 0.790 (95% CI 0.778–0.801) for EQ-5D-3L and 0.803 (0.790–0.816) for EQ-5D-5L (p < 0.001). A similar pattern was also observed in the detailed cancer-specific analysis.


With greater discriminatory power, convergent validity and lower ceiling, EQ-5D-5L may be preferable to EQ-5D-3L for the assessment of HRQoL among cancer patients. However, higher utility scores derived form EQ-5D-5L may also lead to lower QALY gains than those of 3L potentially in cost-utility studies and underestimation in the burden of disease.

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