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01-07-2015 | Uitgave 7/2015

Quality of Life Research 7/2015

Do health preferences contradict ordering of EQ-5D labels?

Quality of Life Research > Uitgave 7/2015
Benjamin M. Craig, A. Simon Pickard, Kim Rand-Hendriksen



The aim of this study was to test whether the ordering of item labels in EQ-5D instruments disagrees with the preferences of US adults.


A preference inversion occurs when “worse” health along a scale or score is preferred. As a sub-study of the 2013 United States Measurement and Valuation of Health Study, we tested for 33 EQ-5D preference inversions using paired comparisons with unique samples of 50 or more US adults, aged 18 or older. Specifically, we tested whether health preferences contradicted ordering of EQ-5D labels.


The EQ-5D-3L and EQ-5D-Y item labels had no significant preference inversions. The EQ-5D-5L version had preference inversions between Levels 4 and 5. For example, 30 out of 59 respondents (51 %) preferred being “extremely” over “severely anxious or depressed,” contrary to the ordering of labels for that item.


Preference inversions between Levels 4 and 5 on the EQ-5D-5L were tested and confirmed; therefore, valuation studies may find that Levels 4 and 5 have the same value. To mitigate such inversions, labels could be revised or a 4-level version could be considered.

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