Applied Health Economics and Health Policy

, Volume 11, Issue 4, pp 415–425 | Cite as

A Comparison of the EQ-5D-3L and ICECAP-O in an Older Post-Acute Patient Population Relative to the General Population

  • Leah CouznerEmail author
  • Maria Crotty
  • Richard Norman
  • Julie Ratcliffe
Original Research Article



The measurement and valuation of quality of life forms a major component of economic evaluation in health care and is a major issue in health services research. However, differing approaches exist in the measurement and valuation of quality of life from a health economics perspective. While some instruments such as the EQ-5D-3L focus on health-related quality of life alone, others assess quality of life in broader terms, for example, the newly developed ICECAP-O.


The aim of this study was to utilize two generic preference-based instruments, the EQ-5D-3L and the ICECAP-O, to measure and value the quality of life of older adult patients receiving post-acute care. An additional objective was to compare the values obtained by each instrument with those generated from two community-based general population samples.


Data were collected from a clinical patient population of older adults receiving post-acute outpatient rehabilitation or residential transition care and two Australian general population samples of individuals residing in the general community. The individual responses to the ICECAP-O and EQ-5D-3L instruments were scored using recently developed Australian general population algorithms. Empirical comparisons were made of the resulting patient and general population sample values for the total population and dis-aggregated according to age (65–79 and 80+ years) and gender.


A total of 1,260 participants aged 65–99 years (n = 86 clinical patient sample, n = 385 EQ-5D-3L general population sample, n = 789 ICECAP-O general population sample) completed one or both of the EQ-5D-3L and ICECAP-O instruments. As expected, the patient group demonstrated lower quality of life than the general population sample as measured by both quality-of-life instruments. The difference in values between the patient and general population groups was found to be far more pronounced for the EQ-5D-3L than for the ICECAP-O. The ICECAP-O was associated with a mean difference in values of 0.04 (patient group mean 0.753, SD 0.18; general population group mean 0.795, SD 0.17, respectively, p = 0.033). In contrast, the EQ-5D-3L was associated with a mean difference in values of 0.19 (patient group mean 0.595, SD 0.20; general population group mean 0.789, SD 0.02, respectively, p ≤ 0.001).


The study findings illustrate the magnitude of the difference in patient and general population values according to the instrument utilized, and highlight the differences in both the theoretical underpinnings and valuation algorithms for the EQ-5D-3L and ICECAP-O instruments. Further empirical work is required in larger samples and alternative patient groups to investigate the generalizability of the findings presented here.


General Population Sample Australian General Population General Population Group Acute Hospital Admission Health Economics Perspective 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by a Flinders University Research Scholarship; and a National Health and Medical Research Council Health Services Research strategic award grant (Grant Number 402791). The study design was developed by L. Couzner, M. Crotty, and J. Ratcliffe. The data were collected by L. Couzner and R. Norman, and analyzed by L. Couzner with assistance from R. Norman and J. Ratcliffe. The data interpretation was undertaken by L. Couzner, M. Crotty, and J. Ratcliffe, while all authors contributed to the drafting of the manuscript. L. Couzner is the guarantor for the overall content. The authors have no conflicts of interest that are relevant to the content of this article.


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Leah Couzner
    • 1
    Email author
  • Maria Crotty
    • 1
  • Richard Norman
    • 2
  • Julie Ratcliffe
    • 3
  1. 1.Department of Rehabilitation, Aged and Extended CareFlinders UniversityAdelaideAustralia
  2. 2.Centre for Health Economics Research and EvaluationUniversity of Technology SydneySydneyAustralia
  3. 3.Flinders Clinical EffectivenessFlinders UniversityAdelaideAustralia

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