Skip to main content


Log in

SF-6D versus EQ-5D: reasons for differences in utility scores and impact on reported cost-utility

  • Original paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript


The choice of instrument (e.g. EQ-5D vs. SF-6D) can lead to different health-related utility scores, but it is unclear why these differences arise and whether they change cost utility analysis (CUA) results. This paper addresses these issues using a case study where using SF-6D rather EQ-5D led to greater utility gain and a lower cost per QALY for treatment. The paper examines reasons for this difference. This paper finds that an important factor was the inclusion in the SF-6D descriptive system of separate items for “vitality” and “social functioning”, not explicitly included in EQ-5D. Further studies are required that examine the impact of the choice of instrument on cost-utility.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Barton, G.R., Bankart, J., Davis, A.C., Summerfield, Q.A.: Comparing utility scores before and after hearing-aid provision: results according to the EQ-5D, HUI3 and SF-6D. Appl. Health Econ. Health Policy 3(2), 103–105 (2004)

    Article  Google Scholar 

  2. Bharmal, M., Thomas, J. 3rd.: Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health 9(4), 262–271 (2006)

    Article  Google Scholar 

  3. Boonen, A., van der Heijde, D., Landewe, R., van Tubergen, A., Mielants, H., Dougados, M., van der Linden, S.: How do the EQ-5D, SF-6D and the well-being rating scale compare in patients with ankylosing spondylitis? Ann. Rheum. Dis. 66(6), 771–777 (2007)

    Article  Google Scholar 

  4. Brazier, J., Roberts, J., Deverill, M.: The estimation of a preference-based measure of health from the SF-36. J. Health Econ. 21, 271–292 (2002)

    Article  Google Scholar 

  5. Brazier, J., Roberts, J., Tsuchiya, A., Busschbach, J.: A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 13, 873–884 (2004)

    Article  Google Scholar 

  6. Bryan, S., Longworth, L.: Measuring health-related utility: why disparity between EQ-5D and SF-6D? Eur. J. Health Econ. 6, 253–260 (2005)

    Article  Google Scholar 

  7. Dolan, P.: Modelling valuations for EuroQol health states. Med. Care 35, 1095–1108 (1997)

    Article  Google Scholar 

  8. Fisk, J.D., Brown, M.G., Sketris, I.S., Metz, L.M., Murray, T.J., Stadnyk, K.J.: A comparison of health utility measures for the evaluation of multiple sclerosis treatments. J. Neurol. Neurosurg. Psychiatry 76, 58–63 (2005)

    Article  Google Scholar 

  9. Fried, M.W., Shiffman, M.L., Reddy, K.R., Smith, C., Marinos, G., Goncales, F.L. Jr., et al.: Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N. Engl. J. Med. 347(13), 975–982 (2002)

    Article  Google Scholar 

  10. Grieve, R., Roberts, J., Wright, M., Sweeting, M., De Angelis, D., Rosenberg, W., Bassendine, M., Main, J., Thomas, H.: Cost effectiveness of interferon alpha or peginterferon alpha with ribavirin for histologically mild chronic hepatitis C. Gut 55, 1332–1338 (2006)

    Article  Google Scholar 

  11. Lamers, L.M., Bouwmans, C.A.M., van Straten, A., Donker, M.C.H., Hakkaart, L.: Comparison of EQ-5D and SF-6D utilities in mental health patients. Health Econ. 15, 1229–1236 (2006)

    Article  Google Scholar 

  12. Longworth, L., Bryan, S.: An empirical comparison of EQ-5D and SF-6D in liver transplant patients. Health Econ. 12, 1061–1067 (2003)

    Article  Google Scholar 

  13. Manns, M.P., McHutchison, J.G., Gordon, S.C., Rustgi, V., Shiffman, M., Reindollar, R., et al.: PegInterferon alfa-2b plus ribavirin compared to interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 358(9286), 958–965 (2001)

    Article  Google Scholar 

  14. Mara, C.A., Woolcott, J.C., Kopec, J.A., Shojania, K., Offer, R., Brazier, J.E., Esdaile, J.M., Anis, A.H.: A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc. Sci. Med. 60, 1571–1582 (2005)

    Article  Google Scholar 

  15. Michaels, J.A., Campbell, W.B., Brazier, J.E., Macintyre, J.B., Palfreyman, S.J., Ratcliffe, J., Rigby, K.: Randomised clinical trial, observational study and assessment of cost-effectiveness of the treatment of varicose veins (REACTIV trial). Health Technol. Assess. 10(13), 1–196 (2006)

    Google Scholar 

  16. National Institute for Clinical Excellence: Guide to the Methods of Technology Appraisal. NICE, London (2004)

    Google Scholar 

  17. Pickard, S.A., Wang, Z., Walton, S.M., Lee, T.A.: Are decisions using cost-utility analyses robust to the choice of SF-36/SF-12 preferenced-based algorithm? BMC Health Qual. Life Outcomes 3, 1–9 (2005)

    Article  Google Scholar 

  18. Stavem, K., Frøland, S.S., Hellum, K.B.: Comparison of preference-based utilities of the 15D, EQ-5D and SF-6D in patients with HIV/AIDS. Qual. Life Res. 14, 971–980 (2005)

    Article  Google Scholar 

  19. Tidermark, J., Bergström, G., Svensson, O., Törnkvist, H., Ponzer, S.: Responsiveness of the EuroQol (EQ 5-D) and the SF-36 in elderly patients with displaced femoral neck fracture. Qual. Life Res. 12(8), 1069–1079 (2003)

    Article  Google Scholar 

  20. Tsuchiya, A., Brazier, J., Roberts, J.: Comparison of valuation methods used to generate the EQ-5D and the SF-6D value sets. J. Health Econ. 25, 334–346 (2006)

    Article  Google Scholar 

  21. van den Hout, W.B., de Jong, Z., Munneke, M., Hazes, JMW., Breedveld, F.C., Vliet Vlieland, T.P.M.: Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis. Arthritis Rheum. 53, 39–47 (2005)

    Article  Google Scholar 

  22. van Stel H.F., Buskens, E.: Comparison of the SF-6D and the EQ-5D in patients with coronary heart disease. Health Qual. Life Outcomes 4, 1–9 (2006)

    Article  Google Scholar 

  23. Xie, F., Li, S.C., Luo, N., Lo, N.N., Yeo, S.J., Yang, K.Y., Fong, K.Y., Thumboo, J.: Comparison of the EuroQol and short form 6D in Singapore multiethnic Asian knee osteoarthritis patients scheduled for total knee replacement. Arthritis Rheum. 57(6), 1043–1049 (2007)

    Article  Google Scholar 

  24. Wee, H.L., Machin, D., Loke, W.C., Li, S.C., Cheung, Y.B., Luo, N., Feeny, D., Fong, K.Y., Thumboo, J.: Assessing differences in utility scores: a comparison of four widely used preference-based instruments. Value Health 10(4), 256–265 (2007)

    Article  Google Scholar 

  25. Wright, M., Grieve, R., Roberts, J., Main, J., Thomas, H.C., UK Mild Hepatitis C Trial Investigators: Health benefits of antiviral therapy for mild chronic hepatitis C: randomised controlled trial and economic evaluation. Health Technol. Assess. 10(21), 1–113 (2006)

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Richard Grieve.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grieve, R., Grishchenko, M. & Cairns, J. SF-6D versus EQ-5D: reasons for differences in utility scores and impact on reported cost-utility. Eur J Health Econ 10, 15–23 (2009).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: