The Impact of Moving from EQ-5D-3L to -5L in NICE Technology Appraisals



The EuroQol-5 Dimension (EQ-5D) instrument is the National Institute for Health and Care Excellence (NICE)’s preferred measure of health-related quality of life (QoL) in adults. The three-level (3L) value set is currently recommended for use, but the five-level (5L) set is increasingly being used in practice.


We aimed to explore the impact of moving from 3L to 5L in NICE appraisals.


We adapted our existing mapping for use with health state utility values derived from a population where the original distribution of utilities was unknown. We used this mapping to estimate 5L utilities for 21 comparisons of interventions from models used in NICE technology appraisal decision making, covering a range of disease areas.


All utilities increased using 5L, and the differences between highest and lowest utilities decreased. In ten oncology comparisons, using 5L generally increased the incremental quality-adjusted life-years (QALYs) as the benefit from improving survival increased. In four non-oncology comparisons where the intervention improved QoL only, the incremental QALYs decreased as the benefit of improving QoL was reduced. In seven non-oncology comparisons where interventions improved survival and QoL, there was a trade-off between increasing the benefit from survival and decreasing the benefit from improving QoL.


3L and 5L lead to substantially different estimates of incremental QALYs and cost effectiveness. The direction and magnitude of the change is not consistent across case studies. Using 5L instead of 3L may lead to different reimbursement decisions. NICE will face inconsistencies in decision making if it uses 3L and 5L concurrently.

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The authors thank the FORWARD databank, their patient participants and directors Kaleb Michaud and Fred Wolfe. We also thank the companies who gave permission for their models to be considered as case studies in this report. We acknowledge the contributions of Rosie Lovett, Jacoline Bouvy, Jo Richardson, Janet Robertson, and Sophie Cooper at NICE who suggested case studies for inclusion, facilitated access to models and critically reviewed the analysis.

Author information




Monica Hernandez-Alava and Stephen Pudney developed the mapping algorithm and adapted it for use with mean utility scores. Becky Pennington used the algorithm to map utility scores for the case studies, adapted the models to use the 5L utilities and analysed the results. Allan Wailoo conceived the idea for the analysis and provided suggestions and critique of the approach. Becky Pennington drafted the first version of the manuscript, which all authors reviewed and made changes to. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Becky Pennington.

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Conflict of interest

Becky Pennington, Monica Hernandez-Alava, Stephen Pudney and Allan Wailoo have no conflicts of interest.

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Pennington, B., Hernandez-Alava, M., Pudney, S. et al. The Impact of Moving from EQ-5D-3L to -5L in NICE Technology Appraisals. PharmacoEconomics 37, 75–84 (2019).

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