Abstract
Objectives
The present study aimed to provide normative data for the EQ-5D-5L questionnaire in Bulgaria, based on a nationally representative sample.
Methods
Random sampling was used. In September 2018, a total of 1005 respondents (aged 18–89 years) completed the self-administered paper-based EQ-5D-5L questionnaire, including a visual analogue scale (EQ VAS). Health state utility index scores were derived using the directly measured Polish value set.
Results
The study sample was representative of the general Bulgarian population in terms of age, sex, geographical region, educational level, social and professional status. Mean EQ-5D-5L and EQ VAS values decreased from 0.986 and 89.7 (age group 18–24 years) to 0.789 and 53.6 (age group ≥ 75 years), respectively. Perfect health (the “11,111” health state) was reported by half of the population (50.1%), more often by men than women (55.8% vs 44.9%). The most frequently reported complaints characterised pain/discomfort dimension (39.1%), followed by anxiety/depression (34.5%). Although the least commonly reported health limitations concerned the self-care dimension, their frequency (13.6%) was the highest among the seventeen identified EQ-5D-5L population norm studies. The mean severity index score for the whole study sample was 6.96. EQ-5D-5L index was higher in respondents from lower age groups and with a higher average income per household member.
Conclusions
Bulgarian population norms, which were developed for the descriptive part of the EQ-5D-5L and EQ VAS, can be used as reference values. The availability of such normative data should encourage the use of the EQ-5D-5L questionnaire in health-related quality-of-life studies in Bulgaria.
Similar content being viewed by others
References
Puchalski, C.M.: Integrating spirituality into patient care: an essential element of person-centered care. Pol. Arch. Med. Wewn. 123, 491–497 (2013)
World Health Organization: WHOQOL: measuring quality of life, https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/index4.html. Accessed 24 March 2020
Lin, X.J., Lin, I.M., Fan, S.Y.: Methodological issues in measuring health-related quality of life. Tzu Chi Med. J. 25, 8–12 (2013)
Fayers, P.M., Hays, R.: Assessing quality of life in clinical trials. Oxford University Press, Oxford (2005)
Lambert, C.M., Hurst, N.P.: Health economics as an aspect of health outcome: basic principles and application in rheumatoid arthritis. Br. J. Rheumatol. 34, 774–780 (1995)
Golicki, D., Niewada, M.: General population reference values for 3-level EQ-5D (EQ-5D-3L) questionnaire in Poland. Pol. Arch. Med. Wewn. 125, 18–26 (2015)
The National Institute for Health and Care: Guide to the methods of technology appraisal 2013. NICE. https://www.nice.org.uk/process/pmg9/resources/guide-to-the-methods-of-technology-appraisal-2013-pdf-2007975843781/ (2018)
EuroQol Research Foundation: EQ-5D is a recommended tool for use in cost-utility analyses around the globe. https://euroqol.org/eq-5d-is-a-recommended-tool-for-use-in-cost-utility-analyses-around-the-globe/ (2018). Accessed 24 March 2020
Devlin, N.J., Brooks, R.: EQ-5D and the EuroQol Group: past, present and future. Appl. Health Econ. Health Policy. 15, 127–137 (2017)
Bharmal, M., Thomas, J.: Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health. 9, 262–271 (2006)
Herdman, M., Gudex, C., Lloyd, A., Janssen, M., 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, 1727–1736 (2011)
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, 1717–1727 (2013)
Buchholz, I., Janssen, M.F., Kohlmann, T., Feng, Y.S.: A systematic review of studies comparing the measurement properties of the three-level and five-level versions of the EQ-5D. Pharmacoeconomics. 36, 645–661 (2018)
Fayers, P.M., Machin, D.: Quality of life: the assessment, analysis and interpretation of patient-reported outcomes. Wiley, Chichester (2007)
Hinz, A., Kohlmann, T., Stobel-Richter, Y., Zenger, M., Brahler, E.: The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population. Qual. Life Res. 23, 443–447 (2014)
Huber, M.B., Felix, J., Vogelmann, M., Leidl, R.: Health-related quality of life of the general German population in 2015: results from the EQ-5D-5L. Int. J. Environ. Res. Public Health. 14(4), 426 (2017)
Grochtdreis, T., Dams, J., Konig, H.H., Konnopka, A.: Health-related quality of life measured with the EQ-5D-5L: estimation of normative index values based on a representative German population sample and value set. Eur. J. Health Econ. 20, 933–944 (2019)
Wong, E.L., Cheung, A.W., Wong, A.Y., Xu, R.H., Ramos-Goni, J.M., Rivero-Arias, O.: Normative profile of health-related quality of life for Hong Kong general population using preference-based instrument EQ-5D-5L. Value Health. 22, 916–924 (2019)
Purba, F.D., Hunfeld, J.A.M., Iskandarsyah, A., Fitriana, T.S., Sadarjoen, S.S., Passchier, J., Busschbach, J.J.V.: Quality of life of the Indonesian general population: test-retest reliability and population norms of the EQ-5D-5L and WHOQOL-BREF. PLoS ONE 13(5), e0197098 (2018)
Hobbins, A., Barry, L., Kelleher, D., O'Neill, C.: The health of the residents of Ireland: population norms for Ireland based on the EQ-5D-5L descriptive system—a cross sectional study. HRB Open Res 1, 22 (2018)
Shiroiwa, T., Fukuda, T., Ikeda, S., Igarashi, A., Noto, S., Saito, S., Shimozuma, K.: Japanese population norms for preference-based measures: EQ-5D-3L, EQ-5D-5L, and SF-6D. Qual. Life Res. 25, 707–719 (2016)
Golicki, D., Niewada, M.: EQ-5D-5L Polish population norms. Arch. Med. Sci. 13, 191–200 (2017)
Kim, T.H., Jo, M.W., Lee II, S., Kim, S.H., Chung, S.M.: Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual. Life Res. 22, 2245–2253 (2013)
Garcia-Gordillo, M.A., Adsuar, J.C., Olivares, P.R.: Normative values of EQ-5D-5L: in a Spanish representative population sample from Spanish Health Survey, 2011. Qual. Life Res. 25, 1313–1321 (2016)
Hernandez, G., Garin, O., Pardo, Y., Vilagut, G., Pont, A., Suarez, M., Neira, M., Rajmil, L., Gorostiza, I., Ramallo-Farina, Y., Cabases, J., Alonso, J., Ferrer, M.: Validity of the EQ-5D-5L and reference norms for the Spanish population. Qual. Life Res. 27, 2337–2348 (2018)
Bailey, H., Janssen, M.F., La Foucade, A., Kind, P.: EQ-5D-5L population norms and health inequalities for Trinidad and Tobago. PLoS ONE 14(4), e0214283 (2019)
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, 93–99 (2014)
Augustovski, F., Rey-Ares, L., Irazola, V., Garay, O.U., Gianneo, O., Fernandez, G., Morales, M., Gibbons, L., Ramos-Goni, J.M.: An EQ-5D-5L value set based on Uruguayan population preferences. Qual. Life Res. 25, 323–333 (2016)
Nguyen, L.H., Tran, B.X., Le Hoang, Q.N., Tran, T.T., Latkin, C.A.: Quality of life profile of general Vietnamese population using EQ-5D-5L. Health Qual. Life Outcomes. 15, 199 (2017)
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)
Yang, Z., Busschbach, J., Liu, G., Luo, N.: EQ-5D-5L norms for the urban Chinese population in China. Health Qual. Life Outcomes. 16, 210 (2018)
McCaffrey, N., Kaambwa, B., Currow, D.C., Ratcliffe, J.: Health-related quality of life measured using the EQ-5D-5L: South Australian population norms. Health Qual. Life Outcomes. 14, 1–12 (2016)
Poder, T.G., Carrier, N., Kouakou, C.R.C.: Quebec health-related quality-of-life population norms using the EQ-5D-5L: decomposition by sociodemographic data and health problems. Value Health. 23, 251–259 (2020)
EuroQol Research Foundation. EQ-5D-5L User Guide. https://euroqol.org/publications/user-guides/ (2019). Accessed 24 March 2020
Golicki, D., Jakubczyk, M., Graczyk, K., Niewada, M.: Valuation of EQ-5D-5L Health States in Poland: the first EQ-VT-based study in Central and Eastern Europe. Pharmacoeconomics. 37, 1165–1176 (2019)
Altman, D.G.: Practical statistics for medical research. Chapman and Hall, London (1991)
Vankova, D., Kerekovska, A., Kostadinova, T., Todorova, L.: Researching health-related quality of life at a community level: results from a population survey conducted in Burgas, Bulgaria. Health Promot. Int. 31, 534–541 (2016)
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Encheva, M., Djambazov, S., Vekov, T. et al. EQ-5D-5L Bulgarian population norms. Eur J Health Econ 21, 1169–1178 (2020). https://doi.org/10.1007/s10198-020-01225-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10198-020-01225-5