EQ-5D-5L is More Responsive than EQ-5D-3L to Treatment Benefit of Cataract Surgery

  • Mihir Gandhi
  • Marcus AngEmail author
  • Kelvin Teo
  • Chee Wai Wong
  • Yvonne Chung-Hsi Wei
  • Rachel Lee-Yin Tan
  • Mathieu F. Janssen
  • Nan Luo
Original Research Article



It is not clear whether 5-level EQ-5D (EQ-5D-5L) utilities based on recently developed value sets are more responsive than 3-level EQ-5D (EQ-5D-3L) utilities.


The study aims were to compare (1) the responsiveness of EQ-5D-5L and EQ-5D-3L utilities and (2) the responsiveness of these utilities with the Short Form–6 Dimension (SF-6D) and Health Utilities Index Mark 3 (HUI3) utilities to the treatment benefit of cataract surgery.


A total of 148 patients were interviewed before and after their cataract surgery using EQ-5D-3L, EQ-5D-5L, SF-6D, and HUI3. Responsiveness was assessed for all measures using the mean change (post-treatment—pre-treatment), standardized effect size (SES), standardized response mean (SRM), and F-statistic.


Using the Singapore value sets, mean change for EQ-5D-3L and EQ-5D-5L utilities was 0.016 and 0.028, SES was 0.097 and 0.199; SRM was 0.091 and 0.196; and F-statistic was 1.2 and 5.7, respectively. Similar trends were observed using the UK/England EQ-5D value sets, although the magnitude was slightly smaller. The mean change, SES, SRM and F-statistics for SF-6D (UK value set) were 0.020, 0.234, 0.249, and 9.2, respectively. The values of mean change, SES, SRM and F-statistics for HUI3 (Canada value set) were 0.080, 0.472, 0.474, and 33.3, respectively.


The EQ-5D-5L utilities tend to be more responsive than the EQ-5D-3L utilities to treatment benefits of cataract surgery. The HUI3 utilities are more responsive than both the EQ-5D-5L and SF-6D, and SF-6D utilities may be slightly more responsive than the EQ-5D-5L for assessing patients undergoing cataract surgery.



We thank the patients of this study for their participation. This study is partially funded by the EuroQol Research Foundation (EQ Project 2016310). Nan Luo and Mathieu F. Janssen are EuroQol Group members who received research Grants from the EuroQol Group. Mihir Gandhi, Marcus Ang, Kelvin Teo, Chee Wai Wong, Yvonne Chung-Hsi Wei, and Rachel Lee-Yin Tan declare no conflict of interest.

Author Contributions

MA, MFJ, and NL jointly conceived the study. KT, CWW, and YCHW contributed in the study design and patient recruitment. RLYT contributed in the data collection form design, patient recruitment and data management. MG analyzed the data and drafted the first version of the manuscript. All authors reviewed and approved the manuscript.

Compliance with Ethical Standards


This study is partially funded by the EuroQol Research Foundation (EQ Project 2016310).

Conflict of interest

Nan Luo and Mathieu F. Janssen are EuroQol Group members who received research grants from the EuroQol Group. Mihir Gandhi, Marcus Ang, Kelvin Teo, Chee Wai Wong, Yvonne Chung-Hsi Wei, and Rachel Lee-Yin Tan declare 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. This article does not contain any studies with animals performed by any of the authors.

Informed consent

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

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Supplementary material

40271_2018_354_MOESM1_ESM.docx (48 kb)
Supplementary material 1 (DOCX 47 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of BiostatisticsSingapore Clinical Research InstituteSingaporeSingapore
  2. 2.Centre for Quantitative MedicineDuke-NUS Medical SchoolSingaporeSingapore
  3. 3.Tampere Center for Child Health ResearchUniversity of Tampere and Tampere University HospitalTampereFinland
  4. 4.Corneal and External Eye Disease DepartmentSingapore National Eye CentreSingaporeSingapore
  5. 5.Opthamology and Visual SciencesDuke-NUS Medical SchoolSingaporeSingapore
  6. 6.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  7. 7.Section Medical Psychology and Psychotherapy, Department of PsychiatryErasmus MCRotterdamNetherlands

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