Skip to main content
SpringerLink
Log in

Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

Abstract

Purpose

To validate and compare the psychometric properties of the EQ-5D-3L with the EQ-5D-5L classification systems in Greece.

Methods

Participants (n = 2279) over 40 years old, sampled from the greater area of Athens using a multistage stratified quota sampling method, completed both EQ-5D versions, while information was also collected on socio-demographics and health-related characteristics. The EQ-5D-5L and EQ-5D-3L were evaluated in terms of agreement, ceiling effects, redistribution and inconsistency, informativity, and convergent and known-groups validity.

Results

The agreement between the EQ-5D-3L and EQ-5D-5L was high (ICC = 0.85). Ceiling effects decreased significantly in the EQ-5D-5L in all domains (P < 0.001), with “usual activities” (−21.4 %) and “self-care” (−20.1 %) showing the highest absolute and “anxiety/depression” the highest relative reduction (−32.46 %). Inconsistency was low (5.7 %). The increase in prevalence of problems was larger than the decrease in their severity, resulting in a lower mean health utility for the EQ-5D-5L. Overall absolute and relative informativity improved by 70.5 % and 16.4 %, respectively, in the EQ-5D-5L. Both instruments exhibited good convergent and known-groups validity, with evidence of a considerably better convergent performance and discriminatory ability of the EQ-5D-5L.

Conclusions

Both EQ-5D versions demonstrated good construct validity and had consistent redistribution. The EQ-5D-5L system may be preferable to the EQ-5D-3L, as it exhibited superior performance in terms of lower ceiling effects, higher absolute and relative informativity, and improved convergent and known-groups validity efficiency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. EuroQol: EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 16(3), 199–208 (1990)

  2. Rabin, R., Oemar, M., Oppe, M.: EQ-5D-3L User Guide, Version 4.0. Rotterdam, The Netherlands: EuroQoL Group (2011)

  3. Rabin, R., Oemar, M., Oppe, M., Janssen, B., Herdman, M.: EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. Version 1.0. In. EuroQol Group, (2011)

  4. Craig, B.M., Pickard, A.S., Lubetkin, E.I.: Health problems are more common, but less severe when measured using newer EQ-5D versions. J. Clin. Epidemiol. 67(1), 93–99 (2014). doi:10.1016/j.jclinepi.2013.07.011

    Article  PubMed  Google Scholar 

  5. Brussoni, M., Kruse, S., Walker, K.: Validity and reliability of the EQ-5D-3L™ among a paediatric injury population. Health Qual. Life Outcomes 11(1), (2013)

  6. Lang, H.C., Chuang, L., Shun, S.C., Hsieh, C.L., Lan, C.F.: Validation of EQ-5D in patients with cervical cancer in Taiwan. Support Care Cancer 18(10), 1279–1286 (2010)

    Article  PubMed  Google Scholar 

  7. Janssen, M.F., Lubetkin, E.I., Sekhobo, J.P., Pickard, A.S.: The use of the EQ-5D preference-based health status measure in adults with Type 2 diabetes mellitus. Diabet. Med. 28(4), 395–413 (2011)

    Article  CAS  PubMed  Google Scholar 

  8. Aburuz, S., Bulatova, N., Twalbeh, M., Gazawi, M.: The validity and reliability of the Arabic version of the EQ-5D: a study from Jordan. Ann. Saudi Med. 29(4), 304–308 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kontodimopoulos, N., Pappa, E., Niakas, D., Yfantopoulos, J., Dimitrakaki, C., Tountas, Y.: Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. Value Health 11(7), 1162–1169 (2008)

    Article  PubMed  Google Scholar 

  10. Van De Willige, G., Wiersma, D., Nienhuis, F.J., Jenner, J.A.: Changes in quality of life in chronic psychiatric patients: a comparison between EuroQol (EQ-5D) and WHOQoL. Qual. Life Res. 14(2), 441–451 (2005). doi:10.1007/s11136-004-0689-y

    Article  PubMed  Google Scholar 

  11. Petrou, S., Hockley, C.: An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Econ. 14(11), 1169–1189 (2005)

    Article  PubMed  Google Scholar 

  12. Petrou, S., Morrell, J., Spiby, H.: Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context. Health Qual. Life Outcomes 7(1), 40 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bharmal, M., Thomas 3rd, J.: Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value health J. Int. Soc. Pharmacoeconomics Outcomes Res. 9(4), 262–271 (2006). doi:10.1111/j.1524-4733.2006.00108.x

    Article  Google Scholar 

  14. Brazier, J., Roberts, J., Tsuchiya, A., Busschbach, J.: A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 13(9), 873–884 (2004). doi:10.1002/hec.866

    Article  PubMed  Google Scholar 

  15. Janssen, M.F., Birnie, E., Haagsma, J.A., Bonsel, G.J.: Comparing the Standard EQ-5D three-level system with a five-level version. Value Health 11(2), 275–284 (2008)

    Article  PubMed  Google Scholar 

  16. Kim, S.H., Kim, H.J., Lee, S.I., Jo, M.W.: Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Qual. Life Res. 21(6), 1065–1073 (2012)

    Article  PubMed  Google Scholar 

  17. Janssen, M.F., Pickard, A.S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., Swinburn, P., Busschbach, J.: Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual. Life Res. 22(7), 1717–1727 (2013). doi:10.1007/s11136-012-0322-4

    Article  CAS  PubMed  Google Scholar 

  18. Pickard, A.S., Kohlmann, T., Janssen, M.F., Bonsel, G., Rosenbloom, S., Cella, D.: Evaluating equivalency between response systems: application of the Rasch model to a 3-level and 5-level EQ-5D. Med. Care. 45(9), 812–819 (2007)

    Article  PubMed  Google Scholar 

  19. Janssen, M.F., Birnie, E., Bonsel, G.J.: Quantification of the level descriptors for the standard EQ-5D three-level system and a five-level version according to two methods. Qual life Res.Int. J. Qual. Life Asp. Treat. care Rehabil. 17(3), 463–473 (2008). doi:10.1007/s11136-008-9318-5

    Article  CAS  Google Scholar 

  20. Luo, N., Li, M., Chevalier, J., Lloyd, A., Herdman, M.: A comparison of the scaling properties of the English, Spanish, French, and Chinese EQ-5D descriptive systems. Qual Life Res., 1–7 (2012). doi:10.1007/s11136-012-0342-0

  21. Kim, T.H., Jo, M.W., Lee, S.i., Kim, S.H., Chung, S.M.: Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual Life Res., 22(8):2245–2253 (2013)

  22. Pickard, A.S., De Leon, M.C., Kohlmann, T., Cella, D., Rosenbloom, S.: Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med. Care 45(3), 259–263 (2007)

    Article  PubMed  Google Scholar 

  23. Scalone, L., Ciampichini, R., Fagiuoli, S., Gardini, I., Fusco, F., Gaeta, L., Del Prete, A., Cesana, G., Mantovani, L.G.: Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases. Qual. Life Res. 22(7), 1707–1716 (2013)

    Article  PubMed  Google Scholar 

  24. Errea, M.: Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations. In: Departamento de Economía-Universidad Pública de Navarra, (2013)

  25. Herdman, M., Gudex, C., Lloyd, A., Janssen, M.F., Kind, P., Parkin, D., Bonsel, G., Badia, X.: Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual. Life Res. 20(10), 1727–1736 (2011). doi:10.1007/s11136-011-9903-x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Tadros, A., Vergou, T., Stratigos, A.J., Tzavara, C., Hletsos, M., Katsambas, A., Antoniou, C.: Psoriasis: is it the tip of the iceberg for the quality of life of patients and their families? J. Eur. Acad. Dermatol. Venereol. 25(11), 1282–1287 (2011)

    Article  CAS  PubMed  Google Scholar 

  27. Rabin, R., de Charro, F.: EQ-5D: a measure of health status from the EuroQol Group. Ann. Med. 33(5), 337–343 (2001)

    Article  CAS  PubMed  Google Scholar 

  28. Bhosle, M.J., Kulkarni, A., Feldman, S.R., Balkrishnan, R.: Quality of life in patients with psoriasis. Health Qual. Life Outcomes 4, 35 (2006). doi:10.1186/1477-7525-4-35

    Article  PubMed  PubMed Central  Google Scholar 

  29. Dolan, P., Gudex, C., Kind, P., Williams, A.: A social tariff for EuroQol: results from a UK general population survey. Cent. Health Econ., (1995)

  30. Brooks, R.: The EuroQol group after 25 years. Springer, Dordrecht (2012)

  31. EuroQol: EQ-5D-5L index value calculator. version 1.0. http://www.euroqol.org/about-eq-5d/valuation-of-eq-5d/eq-5d-5l-value-sets.html (2013). Accessed 10 Μαίου 2013

  32. Van Hout, B., Janssen, M.F., Feng, Y.S., Kohlmann, T., Busschbach, J., Golicki, D., Lloyd, A., Scalone, L., Kind, P., Pickard, A.S.: Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health 15(5), 708–715 (2012). doi:10.1016/j.jval.2012.02.008

    Article  PubMed  Google Scholar 

  33. Brooks, R., EuroQol Group: EuroQol: the current state of play. Health Policy 37(1), 53–72 (1996)

    Article  Google Scholar 

  34. Brooks, R.G.: 28 Years of the EuroQol Group: an overview. EuroQol Working Paper Series. (2015)

  35. Yfantopoulos, J.: The Greek version of the EuroQol (EQ-5D) instrument. Arch. Hell. Med. 18(2), 180–191 (2001)

    Google Scholar 

  36. Terwee, C.B., Bot, S.D., de Boer, M.R., van der Windt, D.A., Knol, D.L., Dekker, J., Bouter, L.M., de Vet, H.C.: Quality criteria were proposed for measurement properties of health status questionnaires. J. Clin. Epidemiol. 60(1), 34–42 (2007)

    Article  PubMed  Google Scholar 

  37. Bland, Martin: J., Altman, D.: statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327(8476), 307–310 (1986)

    Article  Google Scholar 

  38. Whitehurst, D.G.T., Bryan, S., Lewis, M.: Systematic review and empirical comparison of contemporaneous EQ-5D and SF-6D group mean scores. Med. Decis. Mak. 31(6), E34–E44 (2011). doi:10.1177/0272989X11421529

    Article  Google Scholar 

  39. Janssen, M.F.B., Birnie, E., Bonsel, G.J.: Evaluating the discriminatory power of EQ-5D, HUI2 and HUI3 in a US general population survey using Shannon’s indices. Qual. Life Res. 16(5), 895–904 (2007)

    Article  PubMed Central  Google Scholar 

  40. Lloyd, M., Ghelardi, R.J.: A table for calculating theEquitability’Component of species diversity. J. Anim. Ecol., 217–225 (1964)

  41. Heip, C.H., Herman, P.M., Soetaert, K.: Indices of diversity and evenness. Oceanis 24(4), 61–88 (1998)

    Google Scholar 

  42. Barton, G.R., Sach, T.H., Avery, A.J., Jenkinson, C., Doherty, M., Whynes, D.K., Muir, K.R.: A comparison of the performance of the EQ-5D and SF-6D for individuals aged ≥ 45 years. Health Econ. 17(7), 815–832 (2008). doi:10.1002/hec.1298

    Article  PubMed  Google Scholar 

  43. Deng, N., Allison, J.J., Fang, H.J., Ash, A.S., Ware Jr, J.E.: Using the bootstrap to establish statistical significance for relative validity comparisons among patient-reported outcome measures. Health Qual. Life Outcomes 11, 89 (2013). doi:10.1186/1477-7525-11-89

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pickard, A.S., Ray, S., Ganguli, A., Cella, D.: Comparison of FACT- and EQ-5D-based utility scores in cancer. Value Health 15(2), 305–311 (2012). doi:10.1016/j.jval.2011.11.029

    Article  PubMed  Google Scholar 

  45. Wilke, C.T., Pickard, A.S., Walton, S.M., Moock, J., Kohlmann, T., Lee, T.A.: Statistical implications of utility weighted and equally weighted HRQL measures: an empirical study. Health Econ. 19(1), 101–110 (2010)

    PubMed  Google Scholar 

  46. Hays, R., Anderson, R., Revicki, D.: Psychometric considerations in evaluating health-related quality of life measures. Qual. Life Res. 2(6), 441–449 (1993)

    Article  CAS  PubMed  Google Scholar 

  47. Luo, N., Johnson, J.A., Shaw, J.W., Coons, S.J.: Relative efficiency of the EQ-5D, HUI2, and HUI3 index scores in measuring health burden of chronic medical conditions in a population health survey in the USA. Med. Care 47(1), 53–60 (2009). doi:10.1097/MLR.0b013e31817d92f8

    Article  CAS  PubMed  Google Scholar 

  48. Huang, I.C., Willke, R.J., Atkinson, M.J., Lenderking, W.R., Frangakis, C., Wu, A.W.: US and UK versions of the EQ-5D preference weights: does choice of preference weights make a difference? Qual. Life Res. 16(6), 1065–1072 (2007)

    Article  PubMed  Google Scholar 

  49. Cunillera, O., Tresserras, R., Rajmil, L., Vilagut, G., Brugulat, P., Herdman, M., Mompart, A., Medina, A., Pardo, Y., Alonso, J.: Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey. Qual. Life Res. 19(6), 853–864 (2010)

    Article  PubMed  Google Scholar 

  50. Nosyk, B., Sun, H., Guh, D.P., Oviedo-Joekes, E., Marsh, D.C., Brissette, S., Schechter, M.T., Anis, A.H.: The quality of eight health status measures were compared for chronic opioid dependence. J. Clin. Epidemiol. 63(10), 1132–1144 (2010)

    Article  PubMed  Google Scholar 

  51. Zhao, F.L., Yue, M., Yang, H., Wang, T., Wu, J.H., Li, S.C.: Validation and comparison of euroqol and short form 6D in chronic prostatitis patients. Value Health 13(5), 649–656 (2010)

    Article  PubMed  Google Scholar 

  52. García-Gordillo, M.A., del Pozo-Cruz, B., Adsuar, J.C., Sánchez-Martínez, F.I., Abellán-Perpiñán, J.M.: Validation and comparison of 15-D and EQ-5D-5L instruments in a Spanish Parkinson’s disease population sample. Qual. Life Res., 1–12 (2013). doi:10.1007/s11136-013-0569-4

  53. DeLong, E.R., DeLong, D.M., Clarke-Pearson, D.L.: Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3), 837–845 (1988)

    Article  CAS  PubMed  Google Scholar 

  54. Pan, C.W., Sun, H.P., Wang, X., Ma, Q., Xu, Y., Luo, N., Wang, P.: The EQ-5D-5L index score is more discriminative than the EQ-5D-3L index score in diabetes patients. Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation 24(7), 1767–1774 (2015). doi:10.1007/s11136-014-0902-6

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express our sincere appreciation to Dr. Dion Balourdos, Research Director at the National Centre for Social Research (EKKE) for his collaboration with the data source.

Author information

Authors and Affiliations

  1. School of Economics and Political Sciences, University of Athens, 6 Themistokleous Street, 106 78, Athens, Greece

    John N. Yfantopoulos & Athanasios E. Chantzaras

Authors
  1. John N. Yfantopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Athanasios E. Chantzaras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John N. Yfantopoulos.

Ethics declarations

Conflict of interest

The authors have no conflicts to declare.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 48 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yfantopoulos, J.N., Chantzaras, A.E. Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. Eur J Health Econ 18, 519–531 (2017). https://doi.org/10.1007/s10198-016-0807-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-016-0807-0

Keywords

JEL Classification

Search

Navigation