EQ 5D 5L User Guide 2015

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EQ-5D-5L User Guide

Basic information on how to use the EQ-5D-5L instrument

Version 2.1
April 2015
Prepared by
Mandy van Reenen / Bas Janssen

Table of contents
1.

INTRODUCTION ................................................................................................................... 4
1.1.

THE EUROQOL GROUP.................................................................................................... 4

1.2.

EQ-5D........................................................................................................................... 4

1.2.1. EQ-5D-3L ................................................................................................................. 4
1.2.2. EQ-5D-5L ................................................................................................................. 5
1.3.
WHAT IS A HEALTH STATE? .............................................................................................. 9
2.

SCORING THE EQ-5D-5L DESCRIPTIVE SYSTEM .......................................................... 10

SCORING THE EQ VAS ..................................................................................................... 11

CONVERTING EQ-5D-5L STATES TO AN INDEX VALUE ............................................... 12
4.1.

THE EQ-5D-5L CROSSWALK PROJECT........................................................................... 12

4.2.

CROSSWALK VALUE SETS FOR THE EQ-5D-5L ................................................................ 12

ORGANISING EQ-5D-5L DATA ......................................................................................... 14

PRESENTING EQ-5D-5L RESULTS .................................................................................. 15

6.1.

HEALTH PROFILES ......................................................................................................... 15

6.2.

EQ VAS ...................................................................................................................... 17

6.3.

EQ-5D-5L INDEX VALUE ................................................................................................ 17

EQ-5D PRODUCTS ............................................................................................................ 19
7.1.

EQ-5D-5L TRANSLATIONS AND OTHER FORMATS ............................................................ 19

7.2.

OTHER EQ-5D PRODUCTS ............................................................................................ 19

7.2.1. EQ-5D-3L Translations and formats ....................................................................... 19
7.2.2. EQ-5D-Y Translations ............................................................................................ 19
7.3.
TRANSLATION PROCESS ................................................................................................ 20
7.4.
8.

HOW TO OBTAIN EQ-5D-5L? ......................................................................................... 20

FAQS .................................................................................................................................. 21
8.1.

GENERAL ..................................................................................................................... 21

8.2.

REGISTRATION ............................................................................................................. 23

8.3.

COPYRIGHT .................................................................................................................. 23

REFERENCES AND PUBLICATIONS ............................................................................... 24
9.1.

KEY EUROQOL GROUP REFERENCES ............................................................................. 24

9.2.

REFERRING TO THE EQ-5D-5L INSTRUMENT IN PUBLICATIONS .......................................... 24

9.3.

EQ-5D BOOKS ............................................................................................................. 25

1. Introduction
This guide has been developed in order to give users basic information on how to use the EQ-5D-5L version.
Topics include administering the instrument, setting up a database for data collected using EQ-5D-5L as well
as information about how to present the results. Also included are several frequently asked questions
dealing with common issues regarding the use of EQ-5D-5L and a list of currently available EuroQol
products.

1.1. The EuroQol Group


The EuroQol Group is a network of international multidisciplinary researchers devoted to the
measurement of health status. Established in 1987, the EuroQol Group originally consisted of
researchers from Europe, but nowadays includes members from North America, Asia, Africa, Australia,
and New Zealand. The Group is responsible for the development of EQ-5D, a preference based
measure of health status that is now widely used in clinical trials, observational studies and other health
surveys.



The EuroQol Group has been holding annual scientific meetings since its inception in 1987.



The EuroQol Group can be justifiably proud of its collective scientific achievements over the last 20
years. Research areas include: valuation, EQ-5D use in clinical studies and in population surveys,
experimentation with the EQ-5D descriptive system, computerized applications, interpretation of EQ-5D
ratings and the role of EQ-5D in measuring social inequalities in self-reported health.



The EuroQol website (www.euroqol.org) contains detailed information about EQ-5D, guidance for users,
a list of available language versions, EQ-5D references and contact details.

1.2. EQ-5D

EQ-5D is a standardised measure of health status developed by the EuroQol Group in order to
provide a simple, generic measure of health for clinical and economic appraisal1.

Applicable to a wide range of health conditions and treatments, it provides a simple descriptive profile and a
single index value for health status that can be used in the clinical and economic evaluation of health care as
well as in population health surveys. EQ-5D is designed for self-completion by respondents and is ideally
suited for use in postal surveys, in clinics, and in face-to-face interviews. It is cognitively undemanding,
taking only a few minutes to complete. Instructions to respondents are included in the questionnaire.
1.2.1. EQ-5D-3L
The EQ-5D 3 level version (EQ-5D-3L) was introduced in 1990. The EQ-5D-3L essentially consists of 2
pages - the EQ-5D descriptive system (page 2) and the EQ visual analogue scale (EQ VAS) (page 3). The
EQ-5D-3L descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities,
1

EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199-208

Page | 4

pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, extreme
problems. The respondent is asked to indicate his/her health state by ticking (or placing a cross) in the box
against the most appropriate statement in each of the 5 dimensions. The EQ VAS records the respondent’s
self-rated health on a vertical, visual analogue scale where the endpoints are labelled ‘Best imaginable
health state’ and ‘Worst imaginable health state’. This information can be used as a quantitative measure of
health outcome as judged by the individual respondents.
The EQ-5D-3L has now been translated into more than 170 languages and is used worldwide. However
ceiling effects have been reported, particularly when used in general population surveys but also in some
patient population settings. In order to address these criticisms, and encouraged by demand from clinicians
and other users, the EuroQol Group decided to explore ways of improving the EQ-5D’s measurement
properties.
1.2.2. EQ-5D-5L
In 2005, a Task Force was established within the EuroQol Group to investigate methods to improve the
instrument’s sensitivity and to reduce ceiling effects. After much discussion, the Task Force decided that
there should be no change in the number of dimensions for a new version of EQ-5D. However, previously
published studies by EuroQol Group members showed that experimental 5-level versions of EQ-5D could
significantly increase reliability and sensitivity (discriminatory power) while maintaining feasibility and
potentially reducing ceiling effects. The Group therefore decided that the new version of the EQ-5D should
include five levels of severity in each of the existing five EQ-5D dimensions and that it would be called the
EQ-5D-5L (Figure 1)2. The existing EQ-5D was renamed the EQ-5D-3L.
The EQ-5D-5L still consists of 2 pages – the EQ-5D-5L descriptive system (page 2) and the EQ Visual
Analogue scale (EQ VAS) (page 3). The descriptive system comprises the same 5 dimensions as the EQ5D-3L (mobility, self care, usual activities, pain/discomfort, anxiety/depression). However, each dimension
now has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme
problems. The respondent is asked to indicate his/her health state by ticking (or placing a cross) in the box
against the most appropriate statement in each of the 5 dimensions. This decision results in a 1-digit number
expressing the level selected for that dimension. The digits for 5 dimensions can be combined in a 5-digit
number describing the respondent’s health state. It should be noted that the numerals 1-5 have no
arithmetic properties and should not be used as a cardinal score. During the development of the EQ5D-5L, the opportunity was also taken to improve some of the wording in the dimensions to enhance
consistency and facilitate understanding. For example, the old wording of ‘confined to bed’ to indicate the
upper extreme in the EQ-5D-3L has been replaced with ‘I am unable to walk about’ which is more consistent
with the wording within the Mobility dimension and with the extreme levels on other dimensions.
The EQ VAS records the respondent’s self-rated health on a 20 cm vertical, visual analogue scale with
endpoints labelled ‘the best health you can imagine’ and ‘the worst health you can imagine’. This information
can be used as a quantitative measure of health as judged by the individual respondents. The instructions
2
Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new
five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research.

Page | 5

for the EQ VAS task have been changed and simplified in the EQ-5D-5L. The EuroQol Group had received
feedback over the years that respondents sometimes found it difficult to draw a line from the box to the scale.
It was also cumbersome for administrators to record their scores. The EQ-5D-5L now asks respondents to
simply ‘mark an X on the scale to indicate how your health is TODAY’ and then to ‘write the number you
marked on the scale in the box below’. This should make the task easier for both respondents and users.

Page | 6

Figure 1: EQ-5D-5L (UK English sample version)

Under each heading, please tick the ONE box that best describes your health TODAY
MOBILITY
I have no problems in walking about



I have slight problems in walking about



I have moderate problems in walking about



I have severe problems in walking about



I am unable to walk about



SELF-CARE
I have no problems washing or dressing myself



I have slight problems washing or dressing myself



I have moderate problems washing or dressing myself



I have severe problems washing or dressing myself



I am unable to wash or dress myself



USUAL ACTIVITIES (e.g. work, study, housework, family or leisure activities)
I have no problems doing my usual activities



I have slight problems doing my usual activities



I have moderate problems doing my usual activities



I have severe problems doing my usual activities



I am unable to do my usual activities



PAIN / DISCOMFORT
I have no pain or discomfort



I have slight pain or discomfort



I have moderate pain or discomfort



I have severe pain or discomfort



I have extreme pain or discomfort



ANXIETY / DEPRESSION
I am not anxious or depressed



I am slightly anxious or depressed



I am moderately anxious or depressed



I am severely anxious or depressed



I am extremely anxious or depressed



Page | 7

•
•
•

•
•

•
•
•

•
•

We would like to know how good or bad your health is TODAY.
We would like to know how good or bad your health is TODAY.
This scale is numbered from 0 to 100.
This scale is numbered from 0 to 100.
100 means the best health you can imagine.
100 means the best health you can imagine.
0 means the worst health you can imagine.
0 means the worst health you can imagine.
Mark an X on the scale to indicate how your health is TODAY.
Mark an X on the scale to indicate how your health is TODAY.
Now, please write the number you marked on the scale in the box below.
Now, please write the number you marked on the scale in the box below.

YOUR HEALTH TODAY =
YOUR HEALTH TODAY =

Page | 8
Page | 8

1.3. What is a health state?
Each of the 5 dimensions comprising the EQ-5D descriptive system is divided into 5 levels of perceived
problems:
Level 1: indicating no problem
Level 2: indicating slight problems
Level 3: indicating moderate problems
Level 4: indicating severe problems
Level 5: indicating extreme problems
A unique health state is defined by combining 1 level from each of the 5 dimensions.

A total of 3125 possible health states is defined in this way. Each state is referred to in terms of a 5 digit
code. For example, state 11111 indicates no problems on any of the 5 dimensions, while state 12345
indicates no problems with mobility, slight problems with washing or dressing, moderate problems with doing
usual activities, severe pain or discomfort and extreme anxiety or depression.

Page | 9

2. Scoring the EQ-5D-5L descriptive system
The EQ-5D-5L descriptive system should be scored, for example, as follows:

Levels of perceived
problems are coded as

Under
heading,
ONEgroup,
box that
bestindicate
describes
your h
By each
placing
a tick please
in one tick
box the
in each
please
whic
statements
health
TODAYbest describe your health today.
Mobility

MOBILITY

I have no problems in walking about
I have slight problems in walking about
SelfI have
moderate problems in walking about
- about
I have severe problems in walking
I am unable to walk about
Usual Activities
SELF-CARE

I have
no problems
washing
or performing
dressing myself
I have
some problems
with
my usual activities
I have slight problems washing or dressing myself
(e.g.moderate
work, study,
housework,
family
or leisure
activities)
I have
problems
washing
or dressing
myself
I have severe problems washing or dressing myself
I amPain/Discomfort
unable to wash or dress myself

USUAL ACTIVITIES (e.g. work, study, housework,
family or leisure activities)
I have no problems doing my usual activities
I have slight problems doing my usual activities
I have moderate problems doing my usual activities
I have severe problems doing my usual activities
I am unable to do my usual activities




follows:





































PAIN / DISCOMFORT

I have no pain or discomfort
I have slight pain or discomfort
I have moderate pain or discomfort
I have severe pain or discomfort
I have extreme pain or discomfort

ANXIETY / DEPRESSION

I am not anxious or depressed
I am slightly anxious or depressed
I am moderately anxious or depressed
I am severely anxious or depressed
I am extremely anxious or depressed





















Level 1 is
coded as
a ‘1’
Level 2 is
coded as
a ‘2’

Level 3 is
coded as
a ‘3’

Level 4 is
coded as
a ‘4’

Level 5 is
coded as
a ‘5’

This example identifies the health state ‘12345’.

NB: There should be only ONE response for each dimension
NB: Missing values can be coded as ‘9’.
NB: Ambiguous values (e.g. 2 boxes are ticked for a single dimension) should be treated as missing
values.
Page | 10

3. Scoring the EQ VAS
The EQ VAS should be scored, for example, as follows:

For example this
response should be
coded as 77

NB: Missing values should be coded as ‘999’.
NB: If there is a discrepancy between where the respondent has placed the X and the number he/she has
written in the box, administrators should use the number in the box.

Page | 11

4. Converting EQ-5D-5L states to an index value
EQ-5D-5L health states, defined by the EQ-5D-5L descriptive system, may be converted into a
single index value3. The index values, presented in country specific value sets, are a major
feature of the EQ-5D instrument, facilitating the calculation of quality-adjusted life years (QALYs)
that are used to inform economic evaluations of health care interventions. Studies that directly
elicit preferences from general population samples to derive value sets for the EQ-5D-5L are
under development in a number of countries; however, these studies will take time to complete
and for results to be disseminated.

4.1. The EQ-5D-5L Crosswalk Project

In the interim, the EuroQol Group coordinated a study4 that administered both the 3-level and 5level versions of the EQ-5D, in order to develop a “crosswalk” between the EQ-5D-3L value sets
and the new EQ-5D-5L descriptive system, resulting in crosswalk value sets for the EQ-5D-5L. A
total of 3691 respondents completed both the 3L and 5L across 6 countries: Denmark, England,
Italy, the Netherlands, Poland and Scotland. Different subgroups were targeted, and in most
countries, a screening protocol was implemented to ensure that a broad spectrum of levels of
health would be captured across the dimensions of EQ-5D for both the 5L and 3L descriptive
systems.
Several methods were consequently tested to optimize the link function between the two
descriptive systems. The crosswalk link function resulting from this exercise can be used to
calculate index values for EQ-5D-5L, based on the existing value sets for the EQ-5D-3L. Value
sets have been derived for EQ-5D-3L in several countries using visual analogue scale (VAS)
technique or time trade-off (TTO) valuation techniques. The list of currently available value sets
with the number of respondents and valuation technique applied is presented in table 1. Most of
the EQ-5D-3L value sets have been obtained using a representative sample of the general
population, thereby ensuring that they represent the societal perspective. For anyone working
with EQ-5D-3L data, an essential guide to the Group’s available value sets can be found in:
EuroQol Group Monograph series: Volume 2: EQ-5D value sets: inventory, comparative review
and user guide, published by Springer (see section 9.3 for more information).

4.2. Crosswalk value sets for the EQ-5D-5L

EQ-5D-5L value sets are available for each country that performed a valuation study for the EQ5D-3L (table 1). By using the crosswalk link function and the individual responses to the EQ-5D5L descriptive system, index values for the EQ-5D-5L can be calculated. Documents containing
information on the crosswalk project, tables of values for all 3125 health states and the ‘EQ-5D-5L
Crosswalk Index Value Calculator’ can be downloaded from the EuroQol website. The SAS and
SPSS syntax files can be ordered from the EuroQol Office.

3
Many different terms are in use for these index values, such as preference weights, preference-based values, utilities,
QALY weights, etc. Here, we use the term 'index value'.
4
Van Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, Lloyd A, Scalone L, Kind P, Pickard AS.
Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value in Health.

Page | 12

Table 1: List of available value sets for the EQ-5D-3L (references available on the website)

Country
Belgium
Denmark
Denmark
Europe
Finland
France
Germany
Germany
Japan
Netherlands
New Zealand
Slovenia
Spain
Spain
Thailand
UK
UK
US
Zimbabwe

Page | 13

Valuation method

722
1686
1332
8709
1634
443
339
339
621
309
1360
733
300
1000
1324
3395
3395
4048
2440

EQ-5D VAS
EQ-5D VAS
TTO
EQ-5D VAS
EQ-5D VAS
VAS/TTO
EQ-5D VAS
TTO
TTO
TTO
EQ-5D VAS
EQ-5D VAS
EQ-5D VAS
TTO
TTO
EQ-5D VAS
TTO
TTO
TTO

5. Organising EQ-5D-5L data
Data collected using EQ-5D-5L can be entered in a database according to the following schema:

Variable
name
Variable
description

ID
patient
ID
number

SEX
1=Male
2=Female
9=Missing
value

AGE
EDU
999=Missing 1=Low
value
2=Medium
3=High
9=Missing
value

COUNTRY
Country
where data
was
collected

YEAR
Year in
which data
was
collected

MOBILITY
1=No problems,
2=Slight problems
3=Moderate
problems
4=Severe problems
5=Unable to
9=Missing value

Data row 1

1001

1 UK

2011

Data row 2

1002

2 UK

2011

Variable
name
Variable
description

SELFCARE
1=No problems
2=Slight
problems
3=Moderate
problems
4=Severe
problems
5=Unable to
9=Missing value

ACTIVITY
1=No problems
2=Slight
problems
3=Moderate
problems
4=Severe
problems
5=Unable to
9=Missing value

PAIN
1=No pain
2=Slight pain
3=Moderate
pain
4=Severe pain
5=Extreme pain
9=Missing
value

ANXIETY
1=Not anxious
2=Slightly anxious
3=Moderately
anxious
4=Severely
anxious
5=Extremely
anxious 9=Missing
value

STATE
5 digit code
for EQ-5D-5L

EQ_VAS
999=Missing
value

Data row 1

41325

Data row 2

21111

Page | 14

6. Presenting EQ-5D-5L results
Data collected using EQ-5D-5L can be presented in various ways. A basic subdivision can be
made according to the structure of the EQ-5D-5L:
1. Presenting results from the EQ-5D-5L descriptive system as a health profile
2. Presenting results of the EQ VAS as a measure of overall self-rated health status
3. Presenting results from the EQ-5D-5L index value
The way results can be presented is determined both by the data and by what message you, as a
researcher, wish to convey to your audience.

6.1. Health profiles

One way of presenting data as a health profile is by making a table with the frequency or the
proportion of reported problems for each level for each dimension. These tables can be broken
down to include the proportions per subgroup, such as age, before vs. after treatment, treatment
vs. comparator, etc.
Sometimes it is more convenient to dichotomise the EQ-5D-5L levels into 'no problems' (i.e. level
1) and 'problems' (i.e. levels 2 to 5), therefore changing the profile into frequencies of reported
problems. This can be the case, for example, in a general population survey where the numbers
of reported problems are low. Tables 2 and 3 are examples of how to present EQ-5D-5L data in
tabulated form.

Table 2: Percentage of a general population sample reporting levels 1 to 5 by dimension and by age group

AGE GROUPS
EQ-5D DIMENSION

MOBILITY

SELF-CARE

USUAL
ACTIVITY

Page | 15

18-29

30-39

40-49

50-59

60-69

70+

TOTAL

Level 1

95,2%

90,7%

87,2%

67,8%

78,9%

47,1%

86,0%

Level 2

4,4%

8,1%

10,1%

18,6%

14,1%

41,2%

10,2%

Level 3

0,4%

0,6%

2,1%

10,2%

4,2%

5,9%

2,7%

Level 4

0,0%

0,6%

0,5%

3,4%

2,8%

5,9%

1,1%

Level 5

0,0%

Level 1

98,0%

96,9%

97,3%

91,5%

88,2%

95,9%

Level 2

0,4%

1,9%

2,7%

6,8%

8,5%

5,9%

3,0%

Level 3

0,8%

1,2%

0,0%

0,8%

0,0%

5,9%

0,7%

Level 4

0,4%

0,0%

0,1%

Level 5

0,4%

0,0%

0,8%

0,0%

0,2%

Level 1

66,5%

64,6%

54,3%

37,3%

50,7%

41,2%

57,1%

Level 2

30,7%

29,8%

36,7%

41,5%

39,4%

41,2%

34,5%

Level 3

1,6%

5,0%

8,5%

14,4%

7,0%

17,6%

6,6%

Level 4

0,8%

0,6%

0,5%

6,8%

2,8%

0,0%

1,7%

Level 5

0,4%

0,0%

0,1%

AGE GROUPS
EQ-5D DIMENSION

PAIN /
DISCOMFORT

ANXIETY /
DEPRESSION

18-29

30-39

40-49

50-59

60-69

70+

TOTAL

Level 1

79,3%

75,2%

75,0%

78,0%

78,9%

94,1%

77,5%

Level 2

16,3%

19,3%

19,7%

17,8%

15,5%

0,0%

17,5%

Level 3

2,8%

4,3%

2,5%

5,6%

5,9%

3,7%

Level 4

1,2%

1,1%

1,7%

0,0%

1,1%

Level 5

0,4%

0,0%

0,1%

Level 1

92,4%

85,1%

83,5%

65,3%

84,5%

82,4%

84,0%

Level 2

6,8%

9,3%

11,7%

19,5%

9,9%

11,8%

10,7%

Level 3

0,0%

4,3%

3,2%

11,9%

4,2%

5,9%

3,8%

Level 4

0,4%

1,2%

1,6%

3,4%

1,4%

0,0%

1,4%

Level 5

0,4%

0,0%

0,1%

Table 3: Frequency of reported problems for a general population sample by dimension and age group

AGE GROUPS
EQ-5D DIMENSION
MOBILITY
SELF-CARE
USUAL ACTIVITY
PAIN / DISCOMFORT
ANXIETY /
DEPRESSION

18-29

30-39

40-49

50-59

60-69

70-79

TOTAL

No problems

239

146

164

693

Problems

113

No problems
Problems
No problems

246
5
167

156
5
104

183
5
102

108
10
44

65
6
36

15
2
7

773
33
460

Problems
No problems

84
199

57
121

86
141

74
92

35
56

10
16

346
625

Problems
No problems

52
232

40
137

47
157

26
77

15
60

1
14

181
677

Problems

129

In addition to presenting the results in tabulated form, you can also use graphical presentations.
Two (or three) dimensional bar charts can be used to summarise the results in a single graph
(see Figure 2). Figure 2 shows the sum of the proportion of reported levels 2 to 5 for each of the 5
EQ-5D-5L dimensions for 3 different age groups. Older people reported more problems on all
dimensions but the effect of age was strongest for mobility and weakest for anxiety/depression.
Figure 2: Profile of the population (% reporting problem

Page | 16

6.2. EQ VAS

In order to present all aspects of the EQ VAS data, you should present both a measure of the
central tendency and a measure of dispersion. This could be the mean values and the standard
deviations or, if the data are skewed, the median values and the 25th and 75th percentiles. An
example is presented in table 4.
Table 4: EQ VAS values by age – mean + standard deviation and median + percentiles

EQ VAS
Mean
- Std Dev
Median
- 25th
- 75th

AGE GROUPS
18-29
85,7
10,1
88,0
80,0
93,0

30-39
84,3
12,6
89,0
80,0
91,0

40-49
83,7
13,3
88,0
75,0
93,8

50-59
79,7
14,0
80,5
73,3
90,0

60-69
86,1
11,1
90,0
79,0
95,0

70+
79,0
22,6
80,0
73,5
92,0

TOTAL
84,0
12,6
86,0
80,0
92,0

You can present a graphical representation of the data by using bar charts, line charts, or both
(see figure 3). Figure 3 shows the mean EQ VAS scores reported by men, women and both for 7
different age groups. Mean EQ VAS scores are seen to decrease with increasing age. Also, men
in all age groups reported higher EQ VAS scores than women.
Figure 3: Mean population EQ VAS scores by age group and sex

6.3. EQ-5D-5L index value

EQ-5D-5L index values can be presented in much the same way as EQ VAS data, i.e. using both
a measure of central tendency and a measure of dispersion. These can be mean values and
standard deviations (or standard errors, or 95% confidence intervals) or again, if the data are
skewed, median values and the 25th and 75th percentiles. Tables 5 and 6 and figures 4 and 5
show 2 examples of how to present EQ-5D-5L index value results. Table 5 and figure 4 present
the results from a study in which the effect of a treatment on health status is investigated. Table 6
and figure 5 show results for a patient population and 3 subgroups.

Page | 17

Table 5: EQ-5D-5L index values before and after treatment

EQ-Index
Mean
- Std error
Median
- 25th
- 75th
N

Before treatment
0,59
0,012
0,60

After treatment
0,76
0,015
0,70

0,50
0,70

0,65
0,80

120

110

Table 6: EQ-5D-5L index values for the total patient population and the 3 subgroups

EQ-Index
Mean
- Std error
Median
- 25th
- 75th
N

All patients
0,66
0,010
0,55

Subgroup 1
0,45
0,013
0,40

Subgroup 2
0,55
0,015
0,55

Subgroup 3
0,90
0,010
0,95

0,50
0,70

0,30
0,50

0,50
0,60

0,80
1,00

300

100

125

Figure 4: EQ-5D-5L index values before and after treatment: mean values and 95% confidence intervals

Figure 5: Mean EQ-5D-5L index values and 95% confidence intervals for the total patient population and 3
subgroups.

Page | 18

7. EQ-5D Products
7.1. EQ-5D-5L Translations and other formats

The EQ-5D-5L self-complete paper version is currently available in more
than 120 different language versions. Likewise, although the EQ-5D-5L was
primarily designed as a pen-and-paper, self-complete instrument, it is now
available in alternative formats and modes of administration, and in multiple
translations:


PDA



Telephone



Proxy paper



Web



Tablet

If you want to know whether an EQ-5D-5L version exists for your country, please
consult the EuroQol website.

7.2. Other EQ-5D Products
7.2.1. EQ-5D-3L Translations and formats
The EQ-5D-3L (EQ-5D 3 level) self-complete paper version is currently
translated in more than 170 language versions. Likewise, although the EQ-5D3L was also primarily designed as a pen-and-paper self-complete instrument, it is
now available in alternative formats and modes of administration, and in multiple
translations e.g.:


Face-to-face and proxy



Tablet

paper


IVR



Telephone



PDA



Web

If you want to know whether an EQ-5D-3L language version exists for your
country, please consult the EuroQol website.
7.2.2. EQ-5D-Y Translations
The EQ-5D-Y is an EQ-5D-3L self complete youth version has been
developed specifically for children and adolescents aged 8-15 years (or
respectively 8-18 years; see Youth User Guide). At present, this version is
available in more than 30 different languages. Likewise, although the EQ-5D-Y
was primarily designed as a pen-and-paper, self-complete instrument, it is now
available in the following alternative formats:

Page | 19



PDA



Proxy paper



Tablet

7.3. Translation process

All translation/adaptations of the EQ-5D-5L are produced using a standardized translation
protocol that conforms to internationally recognized guidelines. These guidelines aim to ensure
equivalence to the English ‘source’ version and involve a forward/backward translation process
and cognitive debriefing. Only the EuroQol Office can give permission for a translation to be
performed and translations can only be stamped as official if they are performed in cooperation
with EuroQol reviewers.

7.4. How to obtain EQ-5D-5L?

If you require a version that is not available, please first check with the EuroQol Office to ascertain
whether the version is in progress. If the version is not in progress and you are interested in
getting the version (or versions) translated, the policy of the EuroQol Research Foundation is that
you use a specialist agency to carry out the work. The EuroQol Office will refer you to their
preferred agencies who cooperate with the Foundation regularly and are aware of our
requirements. Please note that copyright of all translations remains with the Foundation.

Page | 20

8. FAQs

preceding days or weeks, although EQ-5D-3L

8.1. General

has been tested in recall mode. An early
decision

Is the EQ-5D-5L instrument validated?
The EQ-5D-5L has been validated in a diverse
patient population in 6 countries, including 8
patient

groups

with

chronic

conditions

(cardiovascular disease, respiratory disease,
depression,

diabetes,

liver

disease,

personality disorders, arthritis, stroke) and a
student cohort. Redistribution of responses
from

the

EQ-5D-3L

EQ-5D-5L

was

validated for all dimensions and all levels. The
measurement properties of EQ-5D-5L were
superior

the

EQ-5D-3L

terms

feasibility, ceiling effects, discriminatory power
and

convergent

validity.

Reliability

and

responsiveness remain to be assessed for the
EQ-5D-5L.

the EQ-5D-3L?
Yes, the EQ-5D-5L can be used instead of the
EQ-5D-3L but please bear in mind that
currently there are no value sets available that
directly

elicited

from

representative

general population samples.
For the purpose of comparing EQ-5D results
with previous research based on the EQ-5D3L, or when used in longitudinal research
based on the EQ-5D-3L, it is advised to use
the EQ-5D-3L, or both the EQ-5D-3L and EQ5D-5L
For what period of time does EQ-5D-5L
record health status?
Self-reported health status captured by EQ5D-5L relates to the respondent’s situation at
the time of completion. No attempt is made to
summarise recalled health status over the
Page | 21

the

EuroQol

Group

determined that health status measurement
ought to apply to the respondent’s immediate
situation - hence the focus on ‘your health
today’.
Can I use only the EQ-5D-5L descriptive
system or only the EQ VAS?
We cannot advise this. EQ-5D-5L is a 2-part
instrument so if you only use one part you
cannot claim to have used EQ-5D-5L in your
publications.
How long should the EQ VAS be?
Officially, for paper versions, the EQ VAS
scale should be 20 cm. All methodological and
developmental work has been carried out

Can the EQ-5D-5L now be used instead of

are

taken

using this length. To ensure that you print the
correct length, make sure your paper size is
set at A4 and the box in your printing
instructions labelled ‘scale to paper size’ is set
at ‘no scaling’.
Can I publish our study using EQ-5D?
Yes, you are free to publish your results. If you
are reproducing the EQ-5D-5L, we request
that you use the sample version of EQ-5D-5L.
Also, please include the copyright statement
stated in the footer of the specific EQ-5D-5L
language version.
What is the difference between the EQ-5D5L descriptive system, the EQ VAS and the
EQ-5D index values?
The descriptive system can be represented as
a health state, e.g. health state 21143
represents a patient who indicates slight
problems on the mobility dimension, no

problems on the self-care and usual activities

General population value sets vs. patient

dimensions, severe pain or discomfort, and

population value sets

moderate problems on the anxiety/depression

If you want to undertake a utility analysis you

dimension. These health states can be

will need to use a value set. Generally

converted to a single index value using the

speaking, utility analysis requires a general

crosswalk link function based on the existing

population-based value set (as opposed to a

value sets for the EQ-5D-3L described in

patient-based set). The rationale behind this is

Section 4 above. These EQ-5D-3L value sets

that the values should reflect the preferences

are

valuation

of local taxpayers and potential receivers of

techniques, and reflect the opinion of the

healthcare. Additionally, patients tend to rate

general population. The EQ VAS self-rating

their health states higher than the general

records the respondent’s own assessment of

population because of coping or other factors,

their health status and are therefore not

and may therefore underestimate their need

representative of the general population.

for healthcare. EQ-5D-5L value sets are

Since, the EQ VAS scores are anchored on

therefore based on general population values.

based

VAS

TTO

100 = the best health you can imagine and 0 =
the worst health you can imagine these scores

Multinational clinical trials

are

calculations,

Information relating to EQ-5D-5L health states

whereas the value sets are anchored on

gathered in the context of multinational trials

11111 = 1 and dead = 0 and can therefore be

may be converted into a single index value

used in QALY calculations.

using the crosswalk link function based on the

not suitable for QALY

available EQ-5D-3L value sets as described in
What is the difference between the VAS

Section 4 above. There are different options

and TTO techniques?

available to do this using appropriate value

The difference between the TTO- and VAS-

sets-however the choice depends on the

based value sets is that the techniques used

context in which the information will be used

to elicit the values on which the models are

by researchers or decision makers. In cases

based differ. In the TTO task, respondents are

where data from an international trial are to be

asked to imagine that they will live in a certain

used to inform decision makers in a specific

health state (e.g. 33333) for 10 years and

country, it seems reasonable to expect

have to specify the amount of time they would

decision makers to be interested primarily in

be willing to give up to live in full health

value sets that reflect the values for health

instead (i.e. 11111). For example, someone

states in that country. So for example, if

might find 8 years in 11111 equivalent to 10

applications for reimbursement of a drug are

years in 33333. The VAS technique on the

rolled out from country to country, country-

other hand, asks people to indicate where, on

specific value sets should be applied and

a vertical thermometer-like scale ranging from

reported in each pharmaco-economic report.

best imaginable health to worst imaginable

This is no different from the requirement to

health, they think a health state should be

use country specific costs. In the absence of a

positioned.

country-specific value set, the researcher
should select another set of values for a
population that most closely approximates that

Page | 22

information

amend, convert, translate, publish or make

about index values ('utilities') is required to

available in whatever way (digital, hard-copy

inform researchers or decision makers in an

etc.) the EQ-5D-5L and related proprietary

international context. In these instances, one

materials. The EuroQol Research Foundation

value set applied over all health states data is

stresses that any and all copyrights in the EQ-

probably more appropriate. The decision

5D, its (digital) representations, and its

about which value set to use will also depend

translations exclusively vest in the EuroQol

on whether the relevant decision making body

Research Foundation. EQ-5D™ is a trade

in each country specifies any requirements or

mark of the EuroQol Research Foundation.

country.

Sometimes

however,

preferences in regard to the methodology
used in different contexts (e.g. TTO, standard
gamble

(SG),

VAS

discrete

choice

modelling (DCM)). These guidelines are the
topic of an on-going, international debate but
the EuroQol website is planning to provide a
summary of health care decision-making
bodies internationally together with their stated
requirements regarding the valuation of health
states. Detailed information on valuation
protocols together with guidelines on which
value set to use and tables of all available
value sets has been published by Springer in:
EuroQol Group Monograph series: Volume 2:
EQ-5D value sets: inventory, comparative
review and user guide’ (see section 9.3 for
more information).

8.2. Registration
I am not conducting a study but would like
to use the EQ-5D to measure routine
clinical outcomes or to set-up a registry.
Do I still need to register?
Yes. You can only obtain EQ-5D versions by
completing the EQ-5D Registration Form.

8.3. Copyright
Is the EQ-5D-5L a copyrighted instrument?
Yes. Please note that without the prior written
consent of the EuroQol Office, you are not
permitted to i.e. use, reproduce, alter,
Page | 23

9. References and Publications
9.1. Key EuroQol Group references

1. The EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related
quality of life. Health Policy 16(3):199-208.
2. Brooks R (1996). EuroQol: the current state of play. Health Policy 37(1):53-72.
3. Dolan P (1997). Modeling valuations for EuroQol health states. Med Care 35(11):1095-108.
4. Roset M, Badia X, Mayo NE (1999). Sample size calculations in studies using the EuroQol
5D. Qual Life Res 8(6):539-49.
5. Greiner W, Weijnen T, Nieuwenhuizen M, et al. (2003). A single European currency for EQ5D health states. Results from a six country study. Eur J Health Econ; 4(3):222-231.
6. Shaw JW, Johnson JA, Coons SJ (2005). US valuation of the EQ-5D health states:
development and testing of the D1 valuation model. Med Care; 43(3): 203-220.
7. Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X.
Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
Quality of Life Research.
8. van,Hout B., Janssen,M.F., Feng,Y.S., Kohlmann,T., Busschbach,J., Golicki,D., Lloyd,A.,
Scalone,L., Kind,P., Pickard,A.S. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L
to EQ-5D-3L value sets. Value in Health. 2012 Jul-Aug;15(5):708-15
9. The development of new research methods for the valuation of EQ-5D-5L. European Journal
of Health Economics. Volume 14, Issue 1 Supplement, July 2013.

9.2. Referring to the EQ-5D-5L instrument in publications

When publishing results obtained with the EQ-5D-5L, the following references can be used:
1. The EuroQol Group (1990). EuroQol-a new facility for the measurement of health-related
quality of life. Health Policy 16(3):199-208.
2. Brooks R (1996). EuroQol: the current state of play. Health Policy 37(1):53-72.
3. Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X.
Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
Quality of Life Research.
4. Janssen MF, Pickard AS, 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
If you used the crosswalk value sets for the EQ-5D-5L in your study you can also include a reference
to the publication regarding that crosswalk value set. The appropriate reference is:
1. van,Hout B., Janssen,M.F., Feng,Y.S., Kohlmann,T., Busschbach,J., Golicki,D., Lloyd,A.,
Scalone,L., Kind,P., Pickard,A.S. Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to
EQ-5D-3L value sets. Value in Health. 2012 Jul-Aug;15(5):708-15

Page | 24

9.3. EQ-5D Books
9.3. EQ-5D Books
Self-Reported Population Health: An International Perspective based on EQ5D. Eds.
Szende A,Population
Janssen MF,
Cabases
J. Springer, 2014.
Self-Reported
Health:
An International
Perspective based on EQThis book captures up-to-date and expanded information of EQ-5D self-reported
5D. Eds. Szende A, Janssen MF, Cabases J. Springer, 2014.

health
and
index
values.up-to-date
EQ-5D population
norms information
and cross-country
analyses
are
This
book
captures
and expanded
of EQ-5D
self-reported
provided
from
surveys ofnorms
20 countries
and additional
regional
health
andrepresentative
index values. national
EQ-5D population
and cross-country
analyses
are
surveys.
The
book
can
be
obtained
from
Springer
at
www.springeronline.com
and
is
provided from representative national surveys of 20 countries and additional regional
also surveys.
availableThe
as open-access
book can be book.
obtained from Springer at www.springeronline.com and is
also available as open-access book.
The EuroQol Group after 25 years, Brooks R. Springer, 2013.
This The
bookEuroQol
describes
the history
of the
institutional
administrative
Group
after 25
years,
Brooks and
R. Springer,
2013.framework

within which the EuroQol Group operated. It also presents how the EQ-5D's
This book describes the history of the institutional and administrative framework
descriptive
system
was
determined,
translation
language
were
within which
the
EuroQol
Group how
operated.
It alsoand
presents
howissues
the EQ-5D's
handled,
and how
valuations
were provided.
book and
e-book
can be
obtained
descriptive
system
was determined,
howThe
translation
and
language
issues
were
fromhandled,
Springerand
at www.springeronline.com.
how valuations were provided. The book and e-book can be obtained
from Springer at www.springeronline.com.
EQ-5D value sets: Inventory, comparative review and user guide. Eds. Szende
A, Oppe
M, value
Devlinsets:
N. EuroQol
Group
Monographs
Volume
2. Springer,
2006.
EQ-5D
Inventory,
comparative
review
and user
guide. Eds.
Szende
This A,
book
provides
an essential
guideGroup
to theMonographs
use of the EuroQol
Group’s
value sets
Oppe
M, Devlin
N. EuroQol
Volume
2. Springer,
2006.

for anyone
working
with an
EQ-5D
data guide
and can
be obtained
Springer
at value sets
This book
provides
essential
to the
use of thefrom
EuroQol
Group’s
www.springeronline.com.
for anyone working with EQ-5D data and can be obtained from Springer at
www.springeronline.com.

EQ-5D concepts and methods: a developmental history. Eds Kind P, Brooks R,
Rabin
R. Springer,
2005.
EQ-5D
concepts
and methods: a developmental history. Eds Kind P, Brooks R,
This book is a collection of papers representing the collective intellectual enterprise
Rabin R. Springer, 2005.
of the
EuroQol
Group
and canofbe
obtained
from Springer
at
This
book is
a collection
papers
representing
the collective
intellectual enterprise
www.springeronline.com.
of the EuroQol Group and can be obtained from Springer at
www.springeronline.com.

The Measurement and valuation of health status using EQ-5D: A European
perspective.
Eds Brooks
R,valuation
Rabin R, of
dehealth
Charrostatus
F. Kluwer
The Measurement
and
usingAcacemic
EQ-5D: A European
Publishers,
2005
perspective. Eds Brooks R, Rabin R, de Charro F. Kluwer Acacemic
This Publishers,
book reports2005
on the results of the European Union-funded EQ-net project which
furthered
the development
of results
EQ-5D of
in the
the European
key areas Union-funded
of valuation, application
and which
This book
reports on the
EQ-net project
translation.
The
can be obtained
from
at www.springeronline.com.
furthered
thebook
development
of EQ-5D
in Springer
the key areas
of valuation, application and
translation. The book can be obtained from Springer at www.springeronline.com.
Page | 25
Page | 25

EuroQol Research Foundation
Marten Meesweg 107
3068 AV Rotterdam
The Netherlands
Tel: +31 (0)88 4400190
Email: userinformationservice@euroqol.org
www.euroqol.org
© EuroQol Research Foundation 2015

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