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Comparing EQ-5D-3L and EQ-5D-5L in measuring the HRQoL burden of 4 health conditions in China

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Abstract

Background

EQ-5D-3L has been used in the National Health Services Survey of China since 2008 to monitor population health. The five-level version of EQ-5D was developed, but there lacks evidence to support the use of five-level version of EQ-5D in China. This study was conducted to compare the measurement properties of both the EQ-5D-3L and EQ-5D-5L in quantifying health-related quality of life (HRQoL) burden for 4 different health conditions in China.

Methods

Participants from China were recruited to complete the 3L and 5L questionnaire via Internet. Quota was set to recruit five groups of individuals, with one group of individuals without any health condition and one group of generalized anxiety disorder (GAD), HIV/AIDS, chronic Hepatitis B (CHB), or depression, respectively. The 3L and 5L were compared in terms of response distributions, percentages of reporting ‘no problems’, index value distributions, known-group validity and their relative efficiency.

Results

In total, 500 individuals completed the online survey, including 140 healthy individuals, 122 individuals with hepatitis B, 107 with depression, 90 individuals with GAD and 101 with HIV/AIDS. 5L also had smoother and less clustered index value distributions. Healthy group showed different response distributions to the four condition groups. The percentage of reporting ‘no problems’ decreased significantly in the 5L in all domains (P < 0.01), especially in the pain/discomfort dimension (relative difference: 43.10%). Relative efficiency suggested that 5L had a higher absolute discriminatory power than the 3L version between healthy participant and the other 4 condition groups, especially for the HIV/AIDS group when the 3L results was not significant.

Conclusions

The 5L version may be preferable to the 3L, as it demonstrated superior performance with respect to higher sensitivity to mild health problems, better relative efficiency and responses and index value distributions.

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Abbreviations

HRQoL:

Health-related quality of life

EQ-VAS:

EQ visual analog scale

3L:

EQ-5D-3L

5L:

EQ-5D-5L

E-QALY:

Extending the QALY

SWEMWS:

Short Warwick–Edinburgh Mental Well-being Scale

GAD:

Generalized anxiety disorder

RE:

Relative efficiency

QALYs:

Quality-adjusted life years

DALYs:

Disability-adjusted life years

PRO:

Patient-reported outcome

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Acknowledgements

Not applicable.

Funding

We thank Natural Science Foundation of Guangdong Province (No. 2020A1515010990) to SL and Science and Technology Program of Guangzhou, China (No. 201704020198) for funding this study.

Author information

Authors and Affiliations

  1. College of Pharmacy, Jinan University, 601 West Huangpu avenue, 510632, Guangzhou, People’s Republic of China

    Guizhi Weng, Yanming Hong, Jie Jiang, Zhihao Yang & Sha Li

  2. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Nan Luo

  3. School of Health and Related Research, University of Sheffield, Sheffield, UK

    Clara Mukuria

  4. Dongguan Institute of Jinan University, Dongguan, People’s Republic of China

    Jie Jiang

  5. Health Services Management Department, Guizhou Medical University, Guiyang, People’s Republic of China

    Zhihao Yang

Authors
  1. Guizhi Weng
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  2. Yanming Hong
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  4. Clara Mukuria
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  5. Jie Jiang
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  7. Sha Li
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Contributions

Guizhi Weng contributed to acquisition of data. Zhihao Yang and Yanming Hong analyzed and interpreted the data. Guizhi Weng draft and revise the manuscript. Sha Li, Jie Jiang and Nan Luo contributed to conception, design and the interpretation of the results. Clara Mukuria contributed to the study design and data analysis. All authors reviewed and approved the final version.

Corresponding authors

Correspondence to Zhihao Yang or Sha Li.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

The study was approved by the Ethic Committee of University of Sheffield, United Kingdom. And the committee’s reference number was 025524.

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Appendix

Appendix

See Table 5.

Table 5 Measurement properties of EQ-5D-3L and EQ-5D-5L from published studies
Full size table

Sample size and type of each reference:

1. n = 411, stable angina pectoris

2. n = 227, adolescent idiopathic scoliosis

3. n = 214, systemic lupus erythematosus

4. n = not applicable, Population with Chronic Disease

5. n = 645, chronic hepatitis B

6. n = 220, spondyloarthritis

7. n = 875, haemophilia

8. n = 1802, breast cancer (n = 601), colorectal cancer (n = 601), lung cancer (n = 600)

9. n = 645, hepatitis B

10. n = 416, lung cancer (n = 93), breast cancer (n = 88), liver cancer (n = 67), colorectal cancer (n = 60), thyroid cancer (n = 57), Gastric cancer (n = 51)

11. n = 648, elderly Chinese population

12. n = 168, acute myeloid leukemia

13. n = 11412, hypertension

14. n = 289, diabetes

15. n = 1934, general population

16. n = 1017, hypertension (n = 241), diabetes (n = 241), chronic hepatitis (n = 240), general population (n = 295)

17. n = 180, chronic heart failure

18. n = 113, spondyloarthritis

19. n = 227, adolescent idiopathic scoliosis

20. n = 324, general population

21. n = 441, chronic kidney disease

22. n = 60, cervical cancer

23. n = 141, knee osteoarthritis

24. n = 12950, residents in Southwest China

25. n = 324, Chinese health population

26. n = 362, kashin–Beck Disease

28. n = 298, family caregivers of leukemia patients

28. n = 62, rural residents

29. n = 205, stroke

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Weng, G., Hong, Y., Luo, N. et al. Comparing EQ-5D-3L and EQ-5D-5L in measuring the HRQoL burden of 4 health conditions in China. Eur J Health Econ 24, 197–207 (2023). https://doi.org/10.1007/s10198-022-01465-7

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