Psychometric Comparison of the Standard EQ-5D to a 5 Level Version in Cancer Patients
Abstract
OBJECTIVE: The objectives of this study were: 1) to determine whether expanding the number of levels (ie, response categories) on the standard 3 level EQ-5D (EQ-5D-3L) to 5-levels (EQ-5D-5L) would improve the descriptive richness and ability of the measure to discriminate among different levels of health, and 2) to examine the psychometric properties of each EQ-5D version in patients with cancer. METHODS: U.S.-based cancer patients self-assessed their health using EQ-5D-3L and EQ-5D-5L. These versions were compared in terms of ceiling effects, convergent validity based on correlations with ECOG performance status and FACT-G, discriminative ability using Rasch analysis, and informational richness using Shannon's Evenness Index (J'). RESULTS: A ceiling effect was observed among a greater proportion of respondents to EQ-5D-3L, n=74/424 (17%), compared with EQ-5D-5L, n=47/424 (11%). Within the midlevel of EQ-5D-3L (some problems), substantial partitioning of the sample into the 3 nonextreme levels of the EQ-5D-5L was observed across dimensions. EQ-5D-5L demonstrated a trend towards slightly stronger correlations with ECOG performance status compared with EQ-5D-3L for all dimensions of health, ie, rs (5L/3L): rmobility=0.38/0.31; rself-care=0.35/0.31; rusual activities=0.55/0.47; rpain/discomfort=0.43/0.37; ranxiety/depression=0.23/0.16; rcrude summary score=0.56/0.49. EQ-5D-5L demonstrated a greater relative efficiency and ability to discriminate different levels of health. Informational richness and evenness of EQ-5D-5L was slightly higher (J'5L=0.75) than EQ-5D-3L (J'3L=0.69). CONCLUSION: Evidence supported the validity of both EQ-5D-3L and EQ-5D-5L in cancer. However, results suggest a 5-level classifier system has less ceiling effect and greater discriminative ability with potentially more power to detect differences between groups compared with EQ-5D-3L.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [13]
Compared to the EQ-5D, the EQ-5D-5 L has smaller ceiling and floor effects, and improved reliability and discriminating ability.
“Studies show that compared to the EQ-5D, the EQ-5D-5 L has smaller ceiling and floor effects, and improved reliability and discriminating ability [80, 81].”
Cites
A Mathematical Theory of Communication
Shannon, C. E. (1948) · Bell System Technical Journal · doi:10.1002/j.1538-7305.1948.tb01338.x · Cited by 88,486 · see citing works
Toxicity and response criteria of the Eastern Cooperative Oncology Group
Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., Mcfadden, E. T., & Carbone, P. P. (1982) · American Journal of Clinical Oncology · doi:10.1097/00000421-198212000-00014 · Cited by 11,607 · see citing works
Applied Regression Analysis and Other Multivariable Methods
Walker, E., Kleinbaum, D. G., Kupper, L. L., & Muller, K. E. (1989) · Technometrics · doi:10.2307/1270375 · Cited by 8,538 · see citing works
EQ-SD: a measure of health status from the EuroQol Group
Rabin, R., & Charro, F. D. (2001) · Annals of Medicine · doi:10.3109/07853890109002087 · Cited by 5,613 · see citing works
Applying the Rasch Model: Fundamental Measurement in the Human Sciences
Bond, T. G., & Fox, C. M. (2003) · Journal of Educational Measurement · doi:10.1111/j.1745-3984.2003.tb01103.x · Cited by 4,503 · see citing works
Quality of life and pharmacoeconomics in clinical trials
Pater, J. L. (1996) · Controlled Clinical Trials · doi:10.1016/s0197-2456(97)82191-5 · Cited by 2,412 · see citing works
Wright, B. D., & Masters, G. N. (1982) · ACEReSearch Repository (Australian Council for Educational Research) · Cited by 1,930 · see citing works
Quality of life and pharmacoeconomics in clinical trials
Spilker, B. (1996) · DigitalGeorgetown (Georgetown University Library) · Cited by 1,862 · see citing works
Applied Regression Analysis and Other Multivariable Methods.
Bhattacharyya, H. T., Kleinbaum, D. G., & Kupper, L. L. (1979) · Journal of the American Statistical Association · doi:10.2307/2287012 · Cited by 1,767 · see citing works
(2003) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-1-79 · Cited by 1,506 · see citing works
Applied regression analysis and other multivariable methods
Kleinbaum, D. G. 1. (1998) · Cited by 929 · see citing works
Psychometric considerations in evaluating health-related quality of life measures
Hays, R. D., Anderson, R., & Revicki, D. (1993) · Quality of Life Research · doi:10.1007/bf00422218 · Cited by 513 · see citing works
Weng, L. (2004) · Educational and Psychological Measurement · doi:10.1177/0013164404268674 · Cited by 413 · see citing works
Smith, E. V. (2001) · PubMed · Cited by 311 · see citing works
Comparison of the EQ-5D and SF-12 in an adult US sample
Johnson, J. A., & Coons, S. J. (1998) · Quality of Life Research · doi:10.1023/a:1008809610703 · Cited by 287 · see citing works
Comparing the Standard EQ-5D Three-Level System with a Five-Level Version
Janssen, M. F., Birnie, E., Haagsma, J. A., & Bonsel, G. J. (2008) · Value in Health · doi:10.1111/j.1524-4733.2007.00230.x · Cited by 275 · see citing works
Comparison of the EQ-5D and SF-12 Health Surveys in a General Population Survey in Alberta, Canada
Johnson, J. A., & Pickard, A. S. (2000) · Medical Care · doi:10.1097/00005650-200001000-00013 · Cited by 274 · see citing works
Self-citationKrabbe, P. F. M., Stouthard, M. E. A., Essink‐Bot, M., et al. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00163-2 · Cited by 240 · see citing works
EQ-5D concepts and methods: A developmental history
Kind, P., Brooks, R., & Rabin, R. (2005) · Springer eBooks · doi:10.1007/1-4020-3712-0 · Cited by 208 · see citing works
Quality of life after myocardial infarction
Hillers, T. K., Guyatt, G. H., Oldridge, N., Crowe, J. M., Willan, A. R., Griffith, L. E., & Feeny, D. F. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90134-1 · Cited by 158 · see citing works
The number of levels in the descriptive system
van Agt, H., & Bonsel, G. J. (2005) · Springer eBooks · doi:10.1007/1-4020-3712-0_3 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)
Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., Bonsel, G., & Badia, X. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9903-x · Cited by 9,795 · see citing works
“In terms of the number of levels per dimension, 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].”
BackgroundMethodInterim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets
van Hout, B., Janssen, M. F., Feng, Y.-S., Kohlmann, T., Busschbach, J., Golicki, D., Lloyd, A., Scalone, L., Kind, P., & Pickard, A. S. (2012) · Value in Health · doi:10.1016/j.jval.2012.02.008 · Cited by 2,153 · see citing works
Self-citationJanssen, M. F., Pickard, A. S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., Swinburn, P., & Busschbach, J. (2013) · Quality of Life Research · doi:10.1007/s11136-012-0322-4 · Cited by 1,582 · see citing works
Self-citationEQ-5D and the EuroQol group: past, present and future
Devlin, N. J., & Brooks, R. (2017) · Applied Health Economics and Health Policy · doi:10.1007/s40258-017-0310-5 · Cited by 1,189 · see citing works
Dutch Tariff for the Five-Level Version of EQ-5D
M. Versteegh, M., M. Vermeulen, K., M. A. A. Evers, S., de Wit, G. A., Prenger, R., & A. Stolk, E. (2016) · Value in Health · doi:10.1016/j.jval.2016.01.003 · Cited by 1,113 · see citing works
Psychometric properties of the EQ-5D-5L: a systematic review of the literature
Feng, Y.-S., Kohlmann, T., Janssen, M. F., & Buchholz, I. (2021) · Quality of Life Research · doi:10.1007/s11136-020-02688-y · Cited by 917 · see citing works
Self-citationJanssen, M. F., Birnie, E., & Bonsel, G. J. (2008) · Quality of Life Research · doi:10.1007/s11136-008-9318-5 · Cited by 84 · see citing works
Pickard, A. S., Kohlmann, T., Janssen, M. F., Bonsel, G., Rosenbloom, S., & Cella, D. (2007) · Medical Care · doi:10.1097/mlr.0b013e31805371aa · Cited by 66 · see citing works
Self-citationHernández-Alava, M., & Pudney, S. (2017) · Journal of Health Economics · doi:10.1016/j.jhealeco.2017.06.013 · Cited by 64 · see citing works
Witlox, M., Kraaij, V., Garnefski, N., de Waal, M. W. M., Smit, F., Hoencamp, E., Gussekloo, J., Bohlmeijer, E. T., & Spinhoven, P. (2018) · Trials · doi:10.1186/s13063-018-2731-3 · Cited by 23 · see citing works
- Authors
- Pickard, A. S., De Leon, M. C., Kohlmann, T., Cella, D., & Rosenbloom, S.
- Affiliations
- Edward Hines, Jr. VA Hospital (US)
- Universitätsmedizin Greifswald (DE)
- Northwestern University (US)
- Corresponding author
- Pickard, A Simon
- Venue
- Medical Care
- Published
- 2007-03
- Volume
- 45
- Issue
- 3
- Pages
- 259-263
- ISSN
- 0025-7079 (ISSN-L)
- OpenAlex
- W1970256118
- Cited by
- 259
- References
- 21
- Citations by year
- 2026: 5 · 2025: 19 · 2024: 15 · 2023: 21 · 2022: 31 · 2021: 16 · 2020: 26 · 2019: 12 · 2018: 19 · 2017: 14 · 2016: 9 · 2015: 16 · 2014: 17 · 2013: 4 · 2012: 13
- FWCI
- 13.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Keywords
- EQ-5D-3L, health-related quality of life, cancer patients, ceiling effect, Rasch analysis, convergent validity, ECOG performance status, FACT-G, response categories, self-rated health, health utility measurement, psychometric properties
- MeSH terms
- Activities of Daily Living, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Pain, Psychometrics, Quality of Life, Surveys and Questionnaires, Self Care, Reproducibility of Results
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
