Abstract
The aim of this study was to assess the psychometric properties of the five-level (EQ-5D-5L) in comparison with the standard three-level (EQ-5D-3L) classification systems of the EQ-5D in a sample of psoriatic patients. Psoriatic subjects (n = 396) recruited from 16 private practicing centers from various areas of Greece self-completed the two EQ-5D versions and the Dermatology Life Quality Index, while information was also collected on socio-demographics, clinical characteristics and comorbidities. The EQ-5D-5L and EQ-5D-3L were evaluated in terms of agreement, feasibility, ceiling effects, redistribution properties, inconsistency, informativity, and convergent and known-groups validity. Missing values were negligible in both versions. The agreement between the EQ-5D-5L and the EQ-5D-3L was very high (ICC = 0.94), while the largest differences were identified for subjects with moderate health status. Ceiling effects decreased in the EQ-5D-5L system by 14.08% (p < 0.05), with “anxiety/depression” showing the highest relative reduction (−10.31%; p < 0.05). Overall inconsistency was rather low (1.7%) and respondents preferred to report milder problems in the EQ-5D-5L. Absolute informativity improved by 56.42% in the EQ-5D-5L, while relative informativity declined by 9.24%, with only “anxiety/depression” demonstrating a small increase (6.77%). Both instruments demonstrated good convergent and known-groups validity, with evidence of a slightly better convergent performance and discriminatory efficiency of the EQ-5D-5L. In conclusion, both instruments demonstrated consistency, valid redistribution and good construct validity. The EQ-5D-5L system may be preferable to the EQ-5D-3L in psoriatic patients, as it demonstrated a marginally better performance in terms of reduced ceiling effects, increased informativity, and improved convergent and known-groups validity efficiency, particularly in the domain of “anxiety/depression”.
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References
Ali F, Cueva A, Vyas J, Atwan A, Salek M, Finlay A, Piguet V (2017) A systematic review of the use of quality-of-life instruments in randomized controlled trials for psoriasis. Br J Dermatol 176:577–593
Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R (2006) Quality of life in patients with psoriasis. Health Qual Life Outcomes 4:35. doi:10.1186/1477-7525-4-35
Cohen J (1992) A power primer. Psychol Bull 112:155
Craig BM, Pickard AS, Lubetkin EI (2014) Health problems are more common, but less severe when measured using newer EQ-5D versions. J Clin Epidemiol 67:93–99. doi:10.1016/j.jclinepi.2013.07.011
Cunillera O, Tresserras R, Rajmil L, Vilagut G, Brugulat P, Herdman M, Mompart A, Medina A, Pardo Y, Alonso J (2010) Discriminative capacity of the EQ-5D, SF-6D, and SF-12 as measures of health status in population health survey. Qual Life Res 19:853–864
Davidsson S, Blomqvist K, Molin L, Mork C, Sigurgeirsson B, Zachariae H, Zachariae R (2005) Lifestyle of Nordic people with psoriasis. Int J Dermatol 44:378–383. doi:10.1111/j.1365-4632.2005.01925.x
De Smedt D, Clays E, Doyle F, Kotseva K, Prugger C, Pająk A, Jennings C, Wood D, De Bacquer D (2013) Validity and reliability of three commonly used quality of life measures in a large European population of coronary heart disease patients. Int J Cardiol 167:2294–2299
DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845
Deng N, Allison JJ, Fang HJ, Ash AS, Ware JE Jr (2013) Using the bootstrap to establish statistical significance for relative validity comparisons among patient-reported outcome measures. Health Qual Life Outcomes 11:89. doi:10.1186/1477-7525-11-89
Dolan P, Gudex C, Kind P, Williams A (1995) A social tariff for EuroQol: results from a UK general population survey. CHE Discussion Paper. Centre for Health Economics, University of York, York
Dyer MT, Goldsmith KA, Sharples LS, Buxton MJ (2010) A review of health utilities using the EQ-5D in studies of cardiovascular disease. Health Qual Life Outcomes 8:13. doi:10.1186/1477-7525-8-13
Errea M (2013) Comparing the psychometric properties of the EQ-5D-5L between mental and somatic chronic patients populations. Departamento de Economía-Universidad Pública de Navarra
EuroQol (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208
EuroQol (2013) EQ-5D-5L index value calculator. Version 1.0. http://www.euroqol.org/about-eq-5d/valuation-of-eq-5d/eq-5d-5l-value-sets.html. Accessed 10 Μarch 2013
Finlay AY, Khan GK, Luscombe DK, Salek MS (1990) Validation of Sickness Impact Profile and Psoriasis Disability Index in psoriasis. Br J Dermatol 123:751–756
García-Gordillo MA, del Pozo-Cruz B, Adsuar JC, Sánchez-Martínez FI, Abellán-Perpiñán JM (2013) Validation and comparison of 15-D and EQ-5D-5L instruments in a Spanish Parkinson’s disease population sample. Qual Life Res 23:1315–1326. doi:10.1007/s11136-013-0569-4
Gaujoux-Viala C, Rat AC, Guillemin F, Flipo RM, Fardellone P, Bourgeois P, Fautrel B (2011) Comparison of the EQ-5D and the SF-6D utility measures in 813 patients with early arthritis: results from the ESPOIR cohort. J Rheumatol 38:1576–1584. doi:10.3899/jrheum.101006
Grob JJ, Revuz J, Ortonne JP, Auquier P, Lorette G (2005) Comparative study of the impact of chronic urticaria, psoriasis and atopic dermatitis on the quality of life. Br J Dermatol 152:289–295. doi:10.1111/j.1365-2133.2005.06385.x
Hays R, Anderson R, Revicki D (1993) Psychometric considerations in evaluating health-related quality of life measures. Qual Life Res 2:441–449
Heip CH, Herman PM, Soetaert K (1998) Indices of diversity and evenness. Oceanis 24:61–88
Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736. doi:10.1007/s11136-011-9903-x
Hongbo Y, Thomas CL, Harrison MA, Salek MS, Finlay AY (2005) Translating the science of quality of life into practice: what do dermatology life quality index scores mean? J Investig Dermatol 125:659–664
Huang IC, Willke RJ, Atkinson MJ, Lenderking WR, Frangakis C, Wu AW (2007) US and UK versions of the EQ-5D preference weights: does choice of preference weights make a difference? Qual Life Res 16:1065–1072
Janssen MF, Birnie E, Haagsma JA, Bonsel GJ (2008) Comparing the standard EQ-5D three-level system with a five-level version. Value Health 11:275–284
Janssen MF, Lubetkin EI, Sekhobo JP, Pickard AS (2011) The use of the EQ-5D preference-based health status measure in adults with Type 2 diabetes mellitus. Diabet Med 28:395–413
Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, Swinburn P, Busschbach J (2013) Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res 22:1717–1727. doi:10.1007/s11136-012-0322-4
Janssen MFB, Birnie E, Bonsel GJ (2007) Evaluating the discriminatory power of EQ-5D, HUI2 and HUI3 in a US general population survey using Shannon’s indices. Qual Life Res 16:895–904
Johnson JA, Coons SJ (1998) Comparison of the EQ-5D and SF-12 in an adult US sample. Qual Life Res 7:155–166. doi:10.1023/A:1008809610703
Karelson M, Silm H, Kingo K (2013) Quality of life and emotional state in vitiligo in an estonian sample: comparison with psoriasis and healthy controls. Acta Derm Venereol 93:446–450
Kim GE, Seidler E, Kimball AB (2014) The relative impact of psoriasis and obesity on socioeconomic and medical outcomes in psoriasis patients. J Eur Acad Dermatol Venereol: JEADV 28:216–221. doi:10.1111/jdv.12089
Kim SH, Kim HJ, Lee SI, Jo MW (2012) Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Qual Life Res 21:1065–1073
Kim TH, Jo MW, Lee Si, Kim SH, Chung SM (2012) Psychometric properties of the EQ-5D-5L in the general population of South Korea. Qual Life Res 22:2245–2253
Kontodimopoulos N, Pappa E, Niakas D, Yfantopoulos J, Dimitrakaki C, Tountas Y (2008) Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. Value Health 11:1162–1169
Lang HC, Chuang L, Shun SC, Hsieh CL, Lan CF (2010) Validation of EQ-5D in patients with cervical cancer in Taiwan. Support Care Cancer 18:1279–1286
Langley RG, Ellis CN (2004) Evaluating psoriasis with Psoriasis Area and Severity Index, Psoriasis Global Assessment, and Lattice System Physician’s Global Assessment. J Am Acad Dermatol 51:563–569. doi:10.1016/j.jaad.2004.04.012
Laws PM, Young HS (2012) Associations between skin diseases and quality of life: a comparison of psoriasis, vitiligo, and alopecia areata. Drugs 72:1867–1880
Lee WJ, Song KH, Noh JH, Choi YJ, Jo MW (2012) Health-related quality of life using the EuroQol 5D questionnaire in Korean patients with type 2 diabetes. J Korean Med Sci 27:255–260
Lee YW, Park EJ, Kwon IH, Kim KH, Kim KJ (2010) Impact of psoriasis on quality of life: relationship between clinical response to therapy and change in health-related quality of life. Ann Dermatol 22:389–396. doi:10.5021/ad.2010.22.4.389
Lloyd M, Ghelardi RJ (1964) A table for calculating the equitability’ component of species diversity. J Anim Ecol 33:217–225
Luo N, Johnson JA, Shaw JW, Coons SJ (2009) Relative efficiency of the EQ-5D, HUI2, and HUI3 index scores in measuring health burden of chronic medical conditions in a population health survey in the United States. Med Care 47:53–60. doi:10.1097/MLR.0b013e31817d92f8
Martin Bland J, Altman D (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327:307–310
Mease PJ, Menter MA (2006) Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective. J Am Acad Dermatol 54:685–704. doi:10.1016/j.jaad.2005.10.008
Norlin JM, Steen Carlsson K, Persson U, Schmitt-Egenolf M (2012) Analysis of three outcome measures in moderate to severe psoriasis: a registry-based study of 2450 patients. Br J Dermatol 166:797–802. doi:10.1111/j.1365-2133.2011.10778.x
Nosyk B, Sun H, Guh DP, Oviedo-Joekes E, Marsh DC, Brissette S, Schechter MT, Anis AH (2010) The quality of eight health status measures were compared for chronic opioid dependence. J Clin Epidemiol 63:1132–1144
Nowels D, McGloin J, Westfall JM, Holcomb S (2005) Validation of the EQ-5D quality of life instrument in patients after myocardial infarction. Qual Life Res 14:95–105
Nyunt WW, Low WY, Ismail R, Sockalingam S, Min AK (2013) Determinants of health-related quality of Life in psoriasis patients in Malaysia. Asia Pac J Public Health 15:15
Obradovic M, Lal A, Liedgens H (2013) Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual Life Outcomes 11:110. doi:10.1186/1477-7525-11-110
Pakran J, Riyaz N, Nandakumar G (2011) Determinants of quality of life in psoriasis patients: a cluster analysis of 50 patients. Indian J Dermatol 56:689–693. doi:10.4103/0019-5154.91830
Pereira FRA, Basra MKA, Finlay AY, Salek MS (2012) The role of the EQ-5D in the economic evaluation of dermatological conditions and therapies. Dermatology 225:45–53
Petrou S, Hockley C (2005) An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Econ 14:1169–1189
Petrou S, Morrell J, Spiby H (2009) Assessing the empirical validity of alternative multi-attribute utility measures in the maternity context. Health Qual Life Outcomes 7:40
Pickard AS, De Leon MC, Kohlmann T, Cella D, Rosenbloom S (2007) Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med Care 45:259–263
Pickard AS, Kohlmann T, Janssen MF, Bonsel G, Rosenbloom S, Cella D (2007) Evaluating equivalency between response systems: application of the Rasch model to a 3-level and 5-level EQ-5D. Med Care 45:812–819
Pickard AS, Ray S, Ganguli A, Cella D (2012) Comparison of FACT- and EQ-5D-based utility scores in cancer. Value Health 15:305–311. doi:10.1016/j.jval.2011.11.029
Rabin R, Oemar M, Oppe M (2011) EQ-5D-3L user guide, version 4.0. EuroQoL Group, Rotterdam
Rabin R, Oemar M, Oppe M, Janssen B, Herdman M (2011) EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. Version 1.0. EuroQol Group, Rotterdam
Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM (1999) Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 41:401–407
Sampogna F, Sera F, Abeni D (2004) Measures of clinical severity, quality of life, and psychological distress in patients with psoriasis: a cluster analysis. J Investig Dermatol 122:602–607. doi:10.1046/j.0022-202X.2003.09101.x
Sampogna F, Tabolli S, Abeni D (2012) Living with psoriasis: prevalence of shame, anger, worry, and problems in daily activities and social life. Acta Derm-Venereol 92:299–303
Scalone L, Ciampichini R, Fagiuoli S, Gardini I, Fusco F, Gaeta L, Del Prete A, Cesana G, Mantovani LG (2013) Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases. Qual Life Res 22:1707–1716
Shikiar R, Willian MK, Okun MM, Thompson CS, Revicki DA (2006) The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: results of a phase II study. Health Qual Life Outcomes 4:71. doi:10.1186/1477-7525-4-71
Shintani Y, Kaneko N, Furuhashi T, Saito C, Morita A (2011) Quality of life in patients with psoriasis in northern Taiwan. J Dermatol 38:966–972
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428
Simon Pickard A, Wilke C, Jung E, Patel S, Stavem K, Lee TA (2008) Use of a preference-based measure of health (EQ-5D) in COPD and asthma. Respir Med 102:519–536
Swinburn P, Lloyd A, Boye KS, Edson-Heredia E, Bowman L, Janssen B (2013) Development of a disease-specific version of the EQ-5D-5L for use in patients suffering from psoriasis: lessons learned from a feasibility study in the UK. Value Health 16:1156–1162
Tadros A, Vergou T, Stratigos AJ, Tzavara C, Hletsos M, Katsambas A, Antoniou C (2011) Psoriasis: is it the tip of the iceberg for the quality of life of patients and their families? J Eur Acad Dermatol Venereol: JEADV 25:1282–1287
Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42
Van Hout B, Janssen MF, Feng YS, Kohlmann T, Busschbach J, Golicki D, Lloyd A, Scalone L, Kind P, Pickard AS (2012) Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets. Value Health 15:708–715. doi:10.1016/j.jval.2012.02.008
Wahl AK, Mork C, Lillehol BM, Myrdal AM, Helland S, Hanestad BR, Moum T (2006) Changes in quality of life in persons with eczema and psoriasis after treatment in departments of dermatology. Acta Derm Venereol 86:198–201. doi:10.2340/00015555-0062
Weiss SC, Kimball AB, Liewehr DJ, Blauvelt A, Turner ML, Emanuel EJ (2002) Quantifying the harmful effect of psoriasis on health-related quality of life. J Am Acad Dermatol 47:512–518
Whitehurst DGT, Bryan S, Lewis M (2011) Systematic review and empirical comparison of contemporaneous EQ-5D and SF-6D group mean scores. Med Decis Mak 31:E34–E44. doi:10.1177/0272989X11421529
Wilke CT, Pickard AS, Walton SM, Moock J, Kohlmann T, Lee TA (2010) Statistical implications of utility weighted and equally weighted HRQL measures: an empirical study. Health Econ 19:101–110
Yfantopoulos JN, Chantzaras AE (2016) Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. Eur J Health Econ. doi:10.1007/s10198-016-0807-0
Zhao FL, Yue M, Yang H, Wang T, Wu JH, Li SC (2010) Validation and comparison of euroqol and short form 6D in chronic prostatitis patients. Value Health 13:649–656
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Yfantopoulos, J., Chantzaras, A. & Kontodimas, S. Assessment of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in psoriasis. Arch Dermatol Res 309, 357–370 (2017). https://doi.org/10.1007/s00403-017-1743-2
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DOI: https://doi.org/10.1007/s00403-017-1743-2