The valuation of the EQ-5D in Portugal



The EQ-5D is a preference-based measure widely used in cost-utility analysis (CUA). Several countries have conducted surveys to derive value sets, but this was not the case for Portugal. The purpose of this study was to estimate a value set for the EQ-5D for Portugal using the time trade-off (TTO).


A representative sample of the Portuguese general population (n = 450) stratified by age and gender valued 24 health states. Face-to-face interviews were conducted by trained interviewers. Each respondent ranked and valued seven health states using the TTO. Several models were estimated at both the individual and aggregated levels to predict health state valuations. Alternative functional forms were considered to account for the skewed distribution of these valuations.


The models were analyzed in terms of their coefficients, overall fit and the ability for predicting the TTO values. Random effects models were estimated using generalized least squares and were robust across model specification. The results are generally consistent with other value sets.


This research provides the Portuguese EQ-5D value set based on the preferences of the Portuguese general population as measured by the TTO. This value set is recommended for use in CUA conducted in Portugal.

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  1. 1.

    Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37, 53–72.

    PubMed  Article  CAS  Google Scholar 

  2. 2.

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

    PubMed  Article  CAS  Google Scholar 

  3. 3.

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

    PubMed  Article  Google Scholar 

  4. 4.

    Brazier, J., & Roberts, J. (2004). The estimation of a preference-based measure of health from the SF-12. Medical Care, 42(9), 851–859.

    PubMed  Article  Google Scholar 

  5. 5.

    Torrance, G., Boyle, M., & Horwood, S. (1982). Application of multi-attribute utility theory to measure social preferences for health states. Operations Research, 30(6), 1043–1069.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Torrance, G., Feeny, D., Furlong, W., Barr, R., Zhang, Y., & Wang, Q. (1996). Multi-attribute utility function for a comprehensive health status classification system: Health utilities index mark 2. Medical Care, 34(7), 702–722.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Feeny, D., Furlong, W., Torrance, G., Goldsmith, C., Zhu, Z., DePauw, S., et al. (2002). Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Medical Care, 40(2), 113–128.

    PubMed  Article  Google Scholar 

  8. 8.

    Ferreira, L., & Ferreira, P. (2013). Health state values, methods, Portugal and the UK. In A. Michalos (Ed.), Encyclopedia of quality of life research. Springer (forthcoming).

  9. 9.

    Szende, A., Oppe, M., & Charro, F. d. (2007). Comparative review of time trade-off value sets. In A. Szende, M. Oppe, & N. Devlin (Eds.), EQ-5D value setsinventory, comparative review and user guide (vol. 2, pp. 21–28): EuroQol Group Monographs.

  10. 10.

    Cleemput, I. (2010). A social preference valuations set for EQ-5D health states in Flanders, Belgium. The European Journal Health Economics, 11, 205–213.

    Article  Google Scholar 

  11. 11.

    Wittrup-Jensen, K., Lauridsen, J., Gudex, C., & Pedersen, K. (2009). Generation of a Danish TTO value set for EQ-5D health states. Scandinavian Journal of Public Health, 37(5), 459–466. doi:10.1177/1403494809105287.

    PubMed  Article  Google Scholar 

  12. 12.

    Greiner, W., Claes, C., Busschbach, J., & Schulenburg, J.-M. (2005). Validating the EQ-5D with time trade-off for the German population. The European Journal of Health Economics, 6, 124–130.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Ohinmaa, A., Eija, H., & Sintonen, H. Modelling Euro-Qol values of Finnish adult population. In X. Badia, M. Herdman, & A. Segura (Eds.), EuroQol 1995 Barcelona plenary meeting, Barcelona, 36 October 1996 (pp. 67–76): Institut de Salut Pública de Catalunya.

  14. 14.

    Chevalier, J., & Pouvourville, G. (2012). Valuing EQ-5D using time trade-off in France. The European Journal Health Economics, doi:10.1007/s10198-011-0351-x.

  15. 15.

    Lamers, L., McDonnell, J., Stalmeier, P., Krabbe, P., & Busschbach, J. (2006). The Dutch tariff: Results and arguments for an effective design for national EQ-5D valuation studies. Health Economics, 15(10), 1121–1132.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Golicki, D., Jakubczyk, M., Niewada, M., Wrona, W., & Busschbach, J. (2010). Valuation of EQ-5D health states in Poland: First TTO-based social value set in Central and Eastern Europe. Value in Health, 13(2), 289–297.

    PubMed  Article  Google Scholar 

  17. 17.

    Rupel, V., & Ogorevc, M. (2012). The EQ-5D health states value set for Slovenia. Slovenian Journal of Public Health, 51(2), 128–140.

    Article  Google Scholar 

  18. 18.

    Badia, X., Roset, M., Herdman, M., & Kind, P. (2001). A comparison of United Kingdom and Spanish general population time trade-off values for EQ-5D health states. Medical Decision Making, 21(1), 7–16.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Augustovski, F. A., Irazola, V. E., Velasquez, A. P., Gibbons, L., & Craig, B. M. (2009). Argentin valuation of the EQ-5D health states. Value in Health, 12(4), 587–596.

    PubMed  Article  Google Scholar 

  20. 20.

    Viney, R., Norman, R., King, M. T., Cronin, P., Street, D. J., Knox, S., et al. (2011). Time trade-off derived EQ-5D weights for Australia. Value in Health, 14(6), 928–936.

    PubMed  Article  Google Scholar 

  21. 21.

    Bansback, N., Tsuchiya, A., Brazier, J., & Anis, A. (2012). Canadian valuation of EQ-5D health states: Preliminary value set and considerations for future valuation studies. PLoS ONE, 7(2), e31115. doi:10.1371/journal.pone.0031115.

    PubMed Central  PubMed  Article  CAS  Google Scholar 

  22. 22.

    Tsuchiya, A., Ikeda, S., Ikegami, N., Nishimura, S., Sakai, I., Fukuda, T., et al. (2002). Estimating an EQ-5D population value set: The case of Japan. Health Economics, 11(4), 341–353.

    PubMed  Article  Google Scholar 

  23. 23.

    Devlin, N., Hansen, P., Kind, P., & Williams, A. (2003). Logical inconsistencies in survey respondents’ health state valuations - a methodological challenge for estimating social tariffs. Health Economics, 12(7), 529–544.

    PubMed  Article  Google Scholar 

  24. 24.

    Tongsiri, S., & Cairns, J. (2011). Estimating population-based values for EQ-5D health states in Thailand. Value in Health, 14(8), 1142–1145.

    PubMed  Article  Google Scholar 

  25. 25.

    Shaw, J., Johnson, J., & Coons, S. (2005). US valuation of the EQ-5D health states: Development and testing of the D1 model. Medical Care, 43, 203–220.

    PubMed  Article  Google Scholar 

  26. 26.

    Jelsma, J., Hansen, K., Weerdt, W., Cock, P., & Kind, P. (2003). How do Zimbabweans value health states? Population Health Metrics, 7, 11.

    Article  Google Scholar 

  27. 27.

    Greiner, W., Weijnen, T., Nieuwenhuizen, M., Oppe, S., Badia, X., Busschbach, J., et al. (2003). A single European currency for EQ-5D health states: Results from a six-country study. The European Journal of Health Economics, 4, 222–231.

    PubMed  Article  Google Scholar 

  28. 28.

    Silva, E., Gouveia Pinto, C., Sampaio, C., Pereira, J., Drummond, M., & Trindade, R. (1998). Guidelines for economic drug evaluation studies. Lisbon: INFARMED.

    Google Scholar 

  29. 29.

    Portuguese Statistical Office (2012). Census 2011.

  30. 30.

    Kind, P., Dolan, P., Gudex, C., & Williams, A. (1998). Variations in population health status: Results from a United Kingdom national questionnaire survey. British Medical Journal, 16, 736–741.

    Article  Google Scholar 

  31. 31.

    Agency for Healthcare Research and Quality (2005). EQ-5D Health State Valuation Survey Conducted by Research Triangle Institute on Behalf of the University of Arizona Center for Health Outcomes and PharmacoEconomic Research-Interviewer Book. Accessed 27 Dec 2011.

  32. 32.

    Mann, R., Brazier, J., & Tsuchiya, A. (2009). A comparison of patient and general population weightings of EQ-5D dimensions. Health Economics, 18, 363–372.

    PubMed  Article  Google Scholar 

  33. 33.

    Zarate, V., Kind, P., & Chuang, L.-H. (2008). Hispanic valuation of the EQ-5D health states: A social value set for Latin Americans. Value in Health, 11(7), 1170–1177.

    PubMed  Article  Google Scholar 

  34. 34.

    Bernert, S., Fernández, A., Haro, J., König, H–. H., Alonso, J., Vilagut, G., et al. (2009). Comparison of different valuation methods for population health status measured by the EQ-5D in three European countries. Value in Health, 12(5), 750–758.

    PubMed  Article  Google Scholar 

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We thank the editor and the anonymous reviewers for their constructive comments and suggestions which have considerably improved an earlier version of the article. We acknowledge financial support from the (former) Office of the High Commissioner for Health, Portugal, to conduct the EQ-5D valuation study. We also thank the Fundação para a Ciência e a Tecnologia (FCT) for financing our research centres.

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Correspondence to Lara N. Ferreira.

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Ferreira, L.N., Ferreira, P.L., Pereira, L.N. et al. The valuation of the EQ-5D in Portugal. Qual Life Res 23, 413–423 (2014).

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  • EQ-5D
  • Health-related quality of life
  • QALYs
  • TTO
  • Utility
  • Value set