Evaluating Equivalency Between Response Systems: Application of the Rasch Model to a 3-Level and 5-Level EQ-5D

Pickard, A Simon; Kohlmann, Thomas; Janssen, Mathieu F.; Bonsel, Gouke; Rosenbloom, Sarah; Cella, David

doi:10.1097/mlr.0b013e31805371aa

Cited by 66Health Systems, Economic Evaluations, Quality of LifeEconomic and Environmental ValuationPsychometric Methodologies and Testing

Evaluating Equivalency Between Response Systems: Application of the Rasch Model to a 3-Level and 5-Level EQ-5D

Pickard, A Simon, Kohlmann, Thomas, Janssen, Mathieu F., Bonsel, Gouke, Rosenbloom, Sarah, Cella, David·2007·Medical Care

DOI 10.1097/mlr.0b013e31805371aa

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Abstract

BACKGROUND: Expansion of the EQ-5D health state classifier to 5 levels (EQ-5D-5L) has been proposed to improve discriminative and evaluative properties, but current preference-based algorithms were developed for a 3-level (EQ-5D-3L) structure. The objectives were to examine equivalency of meaning between 3L and 5L response systems, and to psychometrically derive a system of weights that facilitate conversion of 3L preference-based algorithms to a 5L system. METHODS: Rasch models were used to examine the equivalency of the 3L and 5L systems using 2 datasets where health status was assessed using the 3L and 5L: a Dutch study of primarily hypothetical health state assessments and a US-based multicenter study of 423 cancer patients. Category-specific mean values of latent person parameters (using maximum likelihood estimation) for the levels of the 3L and 5L systems were estimated. RESULTS: Means on the latent continuum pertaining to level 3 in the 5L system and level 2 in the 3L (some problems) were similar for both datasets, suggesting equivalence of these levels. Extremes of the 5L response structure consistently broadened the measurement continuum. By anchoring "no problems" as 0 disutility, disutility weights from EQ-5D-3L were transformed into weights for EQ-5D-5L using ratios of logit distances between person means for 5L and 3L calibrated for each dimension using the Rasch model. CONCLUSIONS: This study illustrates the rich potential for modern psychometric techniques both to examine equivalency when health status measures are modified as well as to inform preference-based measurement systems using existing value sets.

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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 [15]

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Self-citation

Authors: Pickard, A. S., Kohlmann, T., Janssen, M. F., Bonsel, G., Rosenbloom, S., & Cella, D.
Affiliations: Edward Hines, Jr. VA Hospital (US)
Universitätsmedizin Greifswald (DE)
Amsterdam UMC Location University of Amsterdam (NL)
Northwestern University (US)
Corresponding author: Pickard, A Simon
ORCID: Pickard, A Simon
Kohlmann, Thomas
Janssen, Mathieu F.
Bonsel, Gouke
Rosenbloom, Sarah
Cella, David
Venue: Medical Care
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2007-09
Volume: 45
Issue: 9
Pages: 812-819
ISSN: 0025-7079 (ISSN-L)
DOI: 10.1097/mlr.0b013e31805371aa
OpenAlex: W2033181937
Cited by: 66
References: 17
Citations by year: 2026: 1 · 2025: 6 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 2 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 6 · 2013: 1 · 2012: 5
FWCI: 10.02
Type: journal article
Language: en
Open access: closed
Locations: Medical Care (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (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 › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
Keywords: EQ-5D-5L, EQ-5D-3L, health status classification, Rasch model, health status measurement, cancer patients, value sets
MeSH terms: Algorithms, Female, United Kingdom, Humans, Male, Models, Psychological, Neoplasms, Netherlands, Psychometrics, Surveys and Questionnaires, Regression Analysis, Severity of Illness Index, Reproducibility of Results, Sickness Impact Profile

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Evaluating Equivalency Between Response Systems: Application of the Rasch Model to a 3-Level and 5-Level EQ-5D

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