Quality of Life Research

, Volume 28, Issue 1, pp 141–152 | Cite as

Validity of the EQ-5D-5L and EQ-5D-3L in patients with Crohn’s disease

  • Fanni RenczEmail author
  • Peter L. Lakatos
  • László Gulácsi
  • Valentin Brodszky
  • Zsuzsanna Kürti
  • Szilvia Lovas
  • János Banai
  • László Herszényi
  • Tamás Cserni
  • Tamás Molnár
  • Márta Péntek
  • Károly Palatka



The EuroQol five-dimension questionnaire (EQ-5D) is the most commonly used instrument to obtain utility values for cost-effectiveness analyses of treatments for Crohn’s disease (CD). We aimed to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with CD.


Between 2016 and 2017, a multicentre cross-sectional survey was carried out. Consecutive outpatients with CD completed the 3L, 5L and EQ visual analogue scale (VAS). Disease severity was graded by the Crohn’s Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). The 3L and 5L were compared in terms of feasibility, agreement, ceiling effect, redistribution properties, discriminatory power, convergent and known-groups validity.


Two-hundred and six patients (54.9% male, mean age 35 ± 11 years) participated in the survey. For 3L, 25 unique health states were observed versus 59 for the 5L. The overall ceiling effect decreased from 29.6% (3L) to 25.5% (5L). Absolute discriminatory power improved (mean Shannon index 0.84 vs. 1.18). The 3L correlated stronger with EQ VAS and CDAI scores, whereas the 5L with PDAI. The 5L demonstrated a better known-groups validity on the basis of age, perianal fistulas, extraintestinal manifestations and disability.


This is the first study to report the impact of CD on quality of life using the EQ-5D-5L questionnaire. The 5L seems to perform better than 3L in terms of feasibility, ceiling effect, discriminatory power and known-groups validity. Understanding the differences in psychometrics between the 3L and 5L is essential as they have substantial implications for financial decision-making about CD treatments.


Crohn’s disease Health-related quality of life EQ-5D Psychometrics 



This research was supported by the Higher Education Institutional Excellence Program of the Ministry of Human Capacities in the framework of the ‘Financial and Public Services’ research project (1783-3/2018/FEKUTSTRAT) at Corvinus University of Budapest. Fanni Rencz is a postdoctoral research fellow at the Hungarian Academy of Sciences (MTA-BCE PPD 462025). Tamás Cserni’s work was supported by the New National Excellence Programme of the Ministry of Human Capacities of Hungary (ÚNKP-17-2-II-BCE-38). The authors are grateful to Drs Lóránt Gönczi, Eszter Schäfer, Tamás Szamosi, Ferenc Zsigmond and Marianna Rutka for their contribution to the data collection.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the National Scientific and Ethical Committee of Hungary (Reference No. 49548-4/2016/EKU).

Informed consent

Informed consent was obtained from all participants included in the study.


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Authors and Affiliations

  1. 1.Department of Health EconomicsCorvinus University of BudapestBudapestHungary
  2. 2.Premium Postdoctoral Research ProgramHungarian Academy of SciencesBudapestHungary
  3. 3.1st Department of MedicineSemmelweis UniversityBudapestHungary
  4. 4.Division of Gastroenterology, McGill University, MUHCMontreal General HospitalMontrealCanada
  5. 5.Division of Gastroenterology, Department of Internal MedicineUniversity of DebrecenDebrecenHungary
  6. 6.Medical CentreHungarian Defence ForcesBudapestHungary
  7. 7.Faculty of EconomicsCorvinus University of BudapestBudapestHungary
  8. 8.1st Department of Internal MedicineUniversity of SzegedSzegedHungary

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