A Head-to-Head Comparison of the EQ-5D-5L and AQoL-8D Multi-Attribute Utility Instruments in Patients Who Have Previously Undergone Bariatric Surgery

  • Julie A. Campbell
  • Andrew J. Palmer
  • Alison Venn
  • Melanie Sharman
  • Petr Otahal
  • Amanda NeilEmail author
Original Research Article



Psychosocial health status is an important and dynamic outcome for bariatric/metabolic surgery patients, as acknowledged in recent international standardised outcomes reporting guidelines. Multi-attribute utility-instruments (MAUIs) capture and assess an individual’s health-related quality-of-life (HRQoL) within a single valuation, their utility. Neither MAUIs nor utilities were discussed in the guidelines. Many MAUIs (e.g. EQ-5D) target physical health. Not so the AQoL-8D.


Our objective was to explore agreement between, and suitability of, the EQ-5D-5L and AQoL-8D for assessing health state utility, and to determine whether either MAUI could be preferentially recommended for metabolic/bariatric surgery patients.


Utilities for post-surgical private-sector patients (n = 33) were assessed using both instruments and summary statistics expressed as mean [standard deviation (SD)] and median [interquartile range (IQR)]. Interchangeability of the MAUIs was assessed with Bland–Altman analysis. Discriminatory attributes were investigated through floor/ceiling effects and dimension-to-dimension comparisons. Spearman’s rank measured associations between the instruments’ utility values and with the body mass index (BMI).


Mean (SD) EQ-5D-5L utility value was 0.84 (0.15) and median 0.84 (IQR 0.75–1.00). Mean (SD) AQoL-8D utility value was 0.76 (0.17) and median 0.81 (IQR 0.63–0.88). Spearman’s rank was r = 0.68; (p < 0.001); however, Bland–Altman analysis revealed fundamental differences. Neither instrument gave rise to floor effects. A ceiling effect was observed with the EQ-5D-5L, with 36 % of participants obtaining a utility value of 1.00 (perfect health). These same participants obtained a mean utility of 0.87 on the AQoL-8D, primarily driven by the mental-super-dimension score (0.52).


The AQoL-8D preferentially captures psychosocial aspects of metabolic/bariatric surgery patients’ HRQoL. We recommend the AQoL-8D as a preferred MAUI for these patients given their complex physical/psychosocial needs.


Ceiling Effect Laparoscopic Adjustable Gastric Band Perfect Health Psychosocial Health HRQoL Instrument 
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.



Julie Campbell contributed to study design, data verification and analysis, manuscript preparation and final approval. Andrew Palmer contributed to study design, manuscript review and final approval. Alison Venn contributed to study design, manuscript review and final approval. Melanie Sharman contributed to data collection and verification, manuscript review and final approval. Petr Otahal contributed to statistical analysis, manuscript review and final approval. Amanda Neil contributed to study design, data analysis, manuscript preparation and final approval. Amanda Neil is the overall guarantor of the submission.

Compliance with Ethical Standards

Disclosure of potential conflicts of interest

This work was supported by a National Health and Medical Research Council (NHMRC) Partnership Project Grant (APP1076899). AV is supported by a NHMRC Research Fellowship. AN is supported by a Select Foundation Research Fellowship.

Research involving human participants

Ethics approval was granted by the University of Tasmania’s Health and Medical Human Research Ethics Committees.

Informed consent

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

Conflict of interest

The authors Julie A. Campbell, Andrew J. Palmer, Alison Venn, Melanie Sharman, Petr Otahal and Amanda Neil declare that they have no conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Julie A. Campbell
    • 1
  • Andrew J. Palmer
    • 1
  • Alison Venn
    • 1
  • Melanie Sharman
    • 1
  • Petr Otahal
    • 1
  • Amanda Neil
    • 1
    Email author
  1. 1.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia

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