Quantification of the level descriptors for the standard EQ-5D three-level system and a five-level version according to two methods
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OBJECTIVES: Our aim was to compare the quantitative position of the level descriptors of the standard EQ-5D three-level system (3L) and a newly developed, experimental five-level version (5L) using a direct and a vignette-based indirect method. METHODS: Eighty-two respondents took part in the study. The direct method represented a visual analog scale (VAS) rating of the nonextreme level descriptors for each dimension and each instrument separately. The indirect method required respondents to score 15 health scenarios with 3L, 5L and a VAS scale. Investigated were: (1) equidistance (Are 3L and 5L level descriptors distributed evenly over the VAS continuum?); (2) isoformity (Do the identical level descriptors on 3L and 5L yield similar results?); and (3) consistency between dimensions (Do the positions of similar level descriptors differ across dimensions within instruments?). RESULTS: Equidistance without transformation was rejected for all dimensions for both 3L and 5L but satisfied for 5L after transformation. Isoformity gave mixed results. Consistency between dimensions was satisfied for both instruments and both methods. DISCUSSION: The level descriptors have similar distributions across comparable dimensions within each system, but the pattern differs between 3L and 5L. This methodological study provides evidence of increased descriptive power and a broadened measurement continuum that encourages the further development of an official five-level EQ-5D.
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Previously published studies by EuroQol Group members showed that prototype 5-level versions of EQ-5D could significantly increase reliability and sensitivity (discriminatory power) while maintaining feasibility and potentially reducing ceiling effects.
“Previously published studies by EuroQol Group members showed that prototype 5-level versions of EQ-5D could significantly increase reliability and sensitivity (discriminatory power) while maintaining feasibility and potentially reducing ceiling effects [12–15].”
From Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) (2011) · cites this paper as [14]
The Introduction and Discussion report that a prototype 5-level EQ-5D had greater discriminatory power and reliability than the 3-level version; the Discussion also predicts a less severe ceiling effect. The Methods > Instruments passage cites feasibility findings for five-point rating formats generally, but does not show that the prototype EQ-5D maintained feasibility. Page numbers are unavailable in our copy. (LLM, conf=0.85)
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References 32 · Cited by 84
Research works printed but not linked: 2
- [16]Szabo S. Spilker B. World Health Organization Quality of Life (WHOQOL) assessment instrument Quality of life and of life and pharmaeconomics in clinical trials 1996 Philadelphia Lippincott-Raven 355 362 Szabo, S. (1996). World Health Organization Quality of Life (WHOQOL) assessment instrument. In B. Spilker (Ed.), Quality of life and of life and pharmaeconomics in clinical trials (pp. 355–362). Philadelphia: Lippincott-Raven.
- [30]Pickard A. S. Kohlmann T. Cella D. Rosenbloom S. Bonsel G. J. Janssen M. F. Come together: Use of IRT models to derive preference-based algorithms for a 5 level version of the EQ-5D Medical Care 2007 45 259 263 10.1097/01.mlr.0000254515.63841.81 17304084 Pickard, A. S., Kohlmann, T., Cella, D., Rosenbloom, S., Bonsel, G. J., & Janssen, M. F. (2007). Come together: Use of IRT models to derive preference-based algorithms for a 5 level version of the EQ-5D. Medical Care, 45, 259–263. 17304084 · DOI · Paper page
- Authors
- Janssen, M. F., Birnie, E., & Bonsel, G. J.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Erasmus MC (NL)
- Corresponding author
- Janssen, M. F.
- Venue
- Quality of Life Research
- Published
- 2008-03-05
- Volume
- 17
- Issue
- 3
- Pages
- 463-473
- ISSN
- 0962-9343 (ISSN-L)
- 1573-2649
- PMC
- PMC2275305
- OpenAlex
- W2155116988
- Cited by
- 84
- References
- 32
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 5 · 2022: 4 · 2021: 12 · 2020: 8 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 4 · 2013: 4 · 2012: 14
- FWCI
- 6.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Quality of Life Research (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- EQ-5D, level descriptors, visual analogue scale, vignette method, equidistance, descriptive power, health state valuation
- MeSH terms
- Anxiety, Depression, Female, Health Status, Health Status Indicators, Health Surveys, Humans, Male, Middle Aged, Pain, Pain Measurement, Psychological Tests, Psychometrics, Quality of Life
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