, Volume 37, Issue 5, pp 715–725 | Cite as

EQ-5D-5L Valuation for the Malaysian Population

  • Asrul Akmal ShafieEmail author
  • Annushiah Vasan Thakumar
  • Ching Jou Lim
  • Nan Luo
  • Kim Rand-Hendriksen
  • Faridah Aryani Md Yusof
Original Research Article



The aim of this study was to develop an EQ-5D-5L value set reflecting the health preferences of the Malaysian adult population.


Respondents were sampled with quotas for urbanicity, gender, age, and ethnicity to ensure representativeness of the Malaysian population. The study was conducted using a standardized protocol involving the EuroQol Valuation Technology (EQ-VT) computer-assisted interview system. Respondents were administered ten composite time trade-off (C-TTO) tasks and seven discrete choice experiment (DCE) tasks. Both linear main effects and constrained non-linear regression models of C-TTO-only data and hybrid models combining C-TTO and DCE data were explored to determine an efficient and informative model for value set prediction.


Data from 1125 respondents representative of the Malaysian population were included in the analysis. Logical consistency was present in all models tested. Using cross-validation, eight-parameter models for C-TTO only and C-TTO + DCE hybrid data displayed greater out-of-sample predictive accuracy than their 20-parameter, main-effect counterparts. The hybrid eight-parameter model was chosen to represent the Malaysian value set, as it displayed greater out-of-sample predictive accuracy over C-TTO data than the C-TTO-only model, and produced more precise estimates. The estimated value set ranged from − 0.442 to 1.


The constrained eight-parameter hybrid model demonstrated the best potential in representing the Malaysian value set. The presence of the Malaysian EQ-5D-5L value set will facilitate its application in research and health technology assessment activities.



The authors thank the interviewers of the study for their dedication to the project. The authors would also like to express gratitude to Rhu Yann Ho, Elly Stolk, Kristina Ludwig, Jan J.V. Busschbach, Arnd Prause, and Juan Manuel Ramos Goñi, for their support during the study. The authors also thank Hospital Universiti Sains Malaysia, Hospital Sungai Buloh, and Segi College Subang Jaya for providing the facilities for this study. Lastly, we would like to thank the Director General of Health Malaysia for his permission to publish this article.

Author Contributions

AAS designed the study and acquired the necessary funding. AAS, AVT, and CJL coordinated the data collection process, assisted by NL and FAMY. KR, NL, AAS, and AVT conceived the analysis. AAS, AVT, and CJL came up with the first draft of the manuscript. Every author contributed in reviewing the analysis, results, and recommended revisions to the final manuscript to ensure accuracy and fair balance.


This study was co-funded by EuroQol Research Foundation and Universiti Sains Malaysia’s Research University Grant (1001/PFARMASI/811287).

Compliance with Ethical Standards

Conflict of interest

Nan Luo and Kim Rand-Hendriksen are members of the EuroQol Research Foundation. Asrul Akmal Shafie, Nan Luo, and Kim Rand-Hendriksen have received grants from EuroQol Research Foundation. There is no other conflict of interest.

Ethical approval

The study received ethical approval from the Malaysia Medical Research & Ethics Committee (ID NMRR-13-1377-18574) and was conducted in accordance with the Declaration of Helsinki.

Informed consent

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

Supplementary material

40273_2018_758_MOESM1_ESM.csv (240 kb)
Supplementary material 1 (CSV 240 kb)


  1. 1.
    Devlin NJ, Brooks R. EQ-5D and the EuroQol Group: past, present and future. Appl Health Econ Health Policy. 2017;15(2):127–37. Scholar
  2. 2.
    Wisløff T, Hagen G, Hamidi V, Movik E, Klemp M, Olsen JA. Estimating QALY gains in applied studies: a review of cost-utility analyses published in 2010. Pharmacoeconomics. 2014;32(4):367–75.CrossRefGoogle Scholar
  3. 3.
    Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72.CrossRefGoogle Scholar
  4. 4.
    Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36. Scholar
  5. 5.
    Brooks R, Rabin R, De Charro F. The measurement and valuation of health status using EQ-5D: a European perspective: evidence from the EuroQol BIO MED research programme. Berlin: Springer Science & Business Media; 2003.Google Scholar
  6. 6.
    Norman R, Cronin P, Viney R, King M, Street D, Ratcliffe J. International comparisons in valuing EQ-5D health states: a review and analysis. Value Health. 2009;12(8):1194–200. Scholar
  7. 7.
    Xie F, Gaebel K, Perampaladas K, Doble B, Pullenayegum E. Comparing EQ-5D valuation studies: a systematic review and methodological reporting checklist. Med Decis Mak. 2014;34(1):8–20. Scholar
  8. 8.
    Oppe M, Devlin NJ, van Hout B, Krabbe PFM, de Charro F. A program of methodological research to arrive at the new international EQ-5D-5L valuation protocol. Value Health J Int Soc Pharmacoecon Outcomes Res. 2014;17(4):445–53.CrossRefGoogle Scholar
  9. 9.
    Xie F, Pullenayegum E, Gaebel K, Bansback N, Bryan S, Ohinmaa A, et al. A time trade-off-derived value set of the EQ-5D-5L for Canada. Med Care. 2016;54(1):98–105. Scholar
  10. 10.
    Augustovski F, Rey-Ares L, Irazola V, Garay O, Gianneo O, Fernández G, et al. An EQ-5D-5L value set based on Uruguayan population preferences. Qual Life Res. 2015;18(7):A810–1. Scholar
  11. 11.
    Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Econ. 2018;27(1):7–22. Scholar
  12. 12.
    Versteegh MM, Vermeulen KM, Evers SM, de Wit GA, Prenger R, Stolk EA. Dutch tariff for the five-level version of EQ-5D. Value Health. 2016;19(4):343–52. Scholar
  13. 13.
    Kim S-H, Ahn J, Ock M, Shin S, Park J, Luo N, et al. The EQ-5D-5L valuation study in Korea. Qual Life Res. 2016;25(7):1845–52. Scholar
  14. 14.
    Ikeda S, Shiroiwa T, Igarashi A, Noto S, Fukuda T, Saito S. Developing a Japanese version of the EQ-5D-5L value set. J Natl Inst Public Health. 2015;64(1):47–55.Google Scholar
  15. 15.
    Ramos-Goñi JM, Pinto-Prades JL, Oppe M, Cabasés JM, Serrano-Aguilar P, Rivero-Arias O. Valuation and modeling of EQ-5D-5L health states using a hybrid approach. Med Care. 2014;55(7):e51–8. Scholar
  16. 16.
    Luo N, Liu G, Li M, Guan H, Jin X, Rand-Hendriksen K. Estimating an EQ-5D-5L value set for China. Value Health. 2017;20(4):662–9. Scholar
  17. 17.
    Wong ELY, Ramos-Goñi JM, Cheung AWL, Wong AYK, Rivero-Arias O. Assessing the use of a feedback module to model EQ-5D-5L health states values in Hong Kong. Patient Patient Centered Outcomes Res. 2018;11(2):235–47. Scholar
  18. 18.
    Purba FD, Hunfeld JAM, Iskandarsyah A, Fitriana TS, Sadarjoen SS, Ramos-Goñi JM, et al. The Indonesian EQ-5D-5L value set. Pharmacoeconomics. 2017;35(11):1153–65. Scholar
  19. 19.
    Ludwig K, Graf von der Schulenburg J-M, Greiner W. German value set for the EQ-5D-5L. Pharmacoeconomics. 2018;36(6):663–74. Scholar
  20. 20.
    Pattanaphesaj J, Thavorncharoensap M, Ramos-Goni JM, Tongsiri S, Ingsrisawang L, Teerawattananon Y. The EQ-5D-5L valuation study in Thailand. Expert Rev Pharmacoecon Outcomes Res. 2018;18(5):551–8. Scholar
  21. 21.
    Hobbins A, Barry L, Kelleher D, Shah K, Devlin N, Goni JMR, et al. Utility values for health states in ireland: a value set for the EQ-5D-5L. Pharmacoeconomics. 2018;36(11):1345–53. Scholar
  22. 22.
    Shafie AA. EuroQol 5-dimension measures in Malaysia. In: Michalos AC, editor. Encyclopedia of quality of life and well-being research. Springer: Berlin; 2014. p. 2041–4.CrossRefGoogle Scholar
  23. 23.
    Oppe M, Van Hout B. The “power” of eliciting EQ-5D-5L values: the experimental design of the EQ-VT. EuroQol working paper series. 2017. p. 17003.Google Scholar
  24. 24.
    Department of Statistics Malaysia. Population distribution and basic demographic characteristic report 2010. Accessed 7 May 2015.
  25. 25.
    Ramos-Goñi JM, Oppe M, Slaap B, Busschbach JJV, Stolk E. Quality control process for EQ-5D-5L valuation studies. Value Health. 2017;20(3):466–73. Scholar
  26. 26.
    Oppe M, Rand-Hendriksen K, Shah K, Ramos-Goñi JM, Luo N. EuroQol protocols for time trade-off valuation of health outcomes. Pharmacoeconomics. 2016;34(10):993–1004. Scholar
  27. 27.
    Bansback N, Brazier J, Tsuchiya A, Anis A. Using a discrete choice experiment to estimate health state utility values. J Health Econ. 2012;31(1):306–18. Scholar
  28. 28.
    Stolk EA, Oppe M, Scalone L, Krabbe PF. Discrete choice modeling for the quantification of health states: the case of the EQ-5D. Value Health. 2010;13(8):1005–13.CrossRefGoogle Scholar
  29. 29.
    Rand-Hendriksen K, Ramos-Goñi JM, Augestad LA, Luo N. Less is more: cross-validation testing of simplified nonlinear regression model specifications for EQ-5D-5L health state values. Value Health. 2017;20(7):945–52. Scholar
  30. 30.
    Oppe M, van Hout B, editors. The optimal hybrid: experimental design and modeling of a combination of TTO and DCE. In: 27th scientific plenary meeting of the EuroQol group-proceedings. Rotterdam: EuroQol Group Executive Office; 2010.Google Scholar
  31. 31.
    Shiroiwa T, Ikeda S, Noto S, Igarashi A, Fukuda T, Saito S, et al. Comparison of value set based on DCE and/or TTO data: scoring for EQ-5D-5L health states in Japan. Value Health. 2016;19(5):648–54. Scholar
  32. 32.
    R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2016.Google Scholar
  33. 33.
    Picard RR, Cook RD. Cross-validation of regression models. J Am Stat Assoc. 1984;79(387):575–83.CrossRefGoogle Scholar
  34. 34.
    Arlot S, Celisse A. A survey of cross-validation procedures for model selection. Stat Surv. 2010;4:40–79.CrossRefGoogle Scholar
  35. 35.
    Rowen D, Brazier J, Van Hout B. A comparison of methods for converting DCE values onto the full health-dead QALY scale. Med Decis Mak. 2015;35(3):328–40. Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Discipline of Social and Administrative PharmacyUniversiti Sains MalaysiaPenangMalaysia
  2. 2.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  3. 3.Health Services Research CentreAkershus University HospitalLørenskogNorway
  4. 4.Pharmacy Practice and Development DivisionMinistry of Health MalaysiaSelangorMalaysia

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