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      Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

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          Abstract

          Purpose

          This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure.

          Methods

          EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions.

          Results

          Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states.

          Conclusions

          A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.

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          Most cited references 15

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          EuroQol: the current state of play.

          The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
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            Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index.

            This study aimed to describe the self-reported health status of the general adult U.S. population using 3 multi-attribute preference-based measures: the EQ-5D, Health Utilities Index Mark 2 (HUI2), and Mark 3 (HUI3). We surveyed the general adult U.S. population using a probability sample with oversampling of Hispanics and non-Hispanic blacks. Respondents to this home-visit survey self-completed the EQ-5D and HUI2/3 questionnaires. Overall health index scores of the target population and selected subgroups were estimated and construct validity of these measures was assessed by testing a priori hypotheses. Completed questionnaires were collected from 4048 respondents (response rate: 59.4%). The majority of the respondents were women (52.0%); the mean age of the sample was 45 years, with 14.8% being 65 or older. Index scores (standard errors) for the general adult U.S. population as assessed by the EQ-5D, HUI2, and HUI3 were 0.87 (0.01), 0.86 (0.01), and 0.81 (0.01), respectively. Generally, younger, male and Hispanic or non-Hispanic black adults had higher (better) index scores than older, female and other racial/ethnic adults; index scores were higher with higher educational attainment and household income. The 3 overall preference indices were strongly correlated (Pearson's r: 0.67-0.87), but systematically different, with intraclass correlation coefficients between these indices ranging from 0.59 to 0.77. This study provides U.S. population norms for self-reported health status on the EQ-5D, HUI2, and HUI3. Although these measures appeared to be valid and demonstrated similarities, health status assessed by these measures is not exactly the same.
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              A national catalog of preference-based scores for chronic conditions in the United States.

              The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf" preference weights associated with conditions that can be used by health researchers without the burden of collecting primary data. The current research responds to the call by developing a nationally representative catalog of preference-based scores for chronic conditions and associated sociodemographic characteristics. The authors report the EQ-5Dindex scores of chronic conditions and associated sociodemographic characteristics in the nationally representative Medical Expenditure Panel Survey (MEPS). Chronic conditions were coded using "quality priority conditions" (QPC) and clinical classification categories (CCC). OLS, Tobit, and censored least absolute deviations (CLAD) regression models were used to provide condition estimates adjusted for age, comorbidity, gender, race, ethnicity, income, and education. Unadjusted and adjusted EQ-5Dindex scores for each QPC and CCC code are presented. EQ-5Dindex scores for older age categories were lower than younger categories, female scores were lower than males, certain racial groups had lower scores than others, and EQ-5Dindex scores were higher for individuals with higher education and income levels. The preference-based chronic condition scores reported in this research are nationally representative and may be useful to researchers to calculate quality-adjusted life-years for cost-effectiveness analyses and population-based burden of illness studies without the difficulty of primary data collection. Further research is necessary to validate these scores in condition-specific studies.
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                Author and article information

                Contributors
                +34-936-035135 , +34-936-035135 , michael.herdman@insightcr.com
                Journal
                Qual Life Res
                Quality of Life Research
                Springer Netherlands (Dordrecht )
                0962-9343
                1573-2649
                9 April 2011
                9 April 2011
                December 2011
                : 20
                : 10
                : 1727-1736
                Affiliations
                [1 ]Insight Consulting and Research, Cami Ral 266 2º 7ª, 08301 Mataró, Spain
                [2 ]CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
                [3 ]Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar), Barcelona, Spain
                [4 ]Department of Endocrinology, Odense University Hospital, Odense, Denmark
                [5 ]Oxford Outcomes, Oxford, United Kingdom
                [6 ]EuroQol Group Executive Office, Rotterdam, The Netherlands
                [7 ]Centre for Health Economics, University of York, York, United Kingdom
                [8 ]NHS South East Coast, Horley, United Kingdom
                [9 ]Perinatal Care and Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
                [10 ]Health Economics and Outcomes Research, IMS Health S.A, Barcelona, Spain
                Article
                9903
                10.1007/s11136-011-9903-x
                3220807
                21479777
                © The Author(s) 2011
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media B.V. 2011

                Public health

                eq-5d, 5 level, health-related quality of life, development

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