Skip to main content
SpringerLink
Log in

Psychometric properties comparison between EQ-5D-5L and EQ-5D-3L in the general Thai population

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

Evidence for the EQ-5D-5L’s psychometric properties in the general Thai population is limited. This study aimed to compare ceiling effect, discriminatory power, response redistribution, validity, reliability between the EQ-5D-5L (5L) and the EQ-5D-3L (3L) in the general Thai population.

Methods

1200 participants were randomly selected. The Shannon index (\({H}^{{\prime}})\) and Shannon evenness index (\({J}^{{\prime}})\) determining discriminatory power of both EQ-5D versions in each dimension were compared. Test–retest reliability was evaluated using weighted kappa (k) and intraclass correlation coefficients (ICCs). Validity was evaluated by correlations between similar dimensions of the EQ-5D, WHOQOL-BREF, and SF-12v2 and known-groups validity. The ceiling effects for the 3L and for the 5L were compared.

Results

The 5L had lower ceiling effects than the 3L (49.08% vs 57.17%, p < 0.01). \({H}^{{\prime}}\) was higher for the 5L than for the 3L, but \({J}^{{\prime}}\) showed otherwise. Moderate correlations were detected between similar dimensions of the EQ-5D and the WHOQOL-BREF and SF-12v2. ICCs and k of the 3L were slightly higher than those of the 5L (ICCs: 0.78 vs 0.71) and (k: 0.42–0.63 vs 0.48–0.61), respectively. Older, female participants and those with comorbidities reported a lower utility index for both versions.

Conclusion

Evidence supported use of both EQ-5D versions in the general Thai population. The 5L had better ceiling effects and discriminant activity, while it showed comparable known-groups validity with the 3L. Nevertheless, evidence is limited for the superiority of reliability between these two versions, so more future research is required to investigate it.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data analyzed and reported in this manuscript is not available for public sharing.

References

  1. Herdman, M., Gudex, C., Lloyd, A., Janssen, M. F., Kind, P., Parkin, D., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research, 20(10), 1727–1736.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Oemar, M., & Janssen, B. (2013). EQ-5D-5L user guide-basic information on how to use the EQ-5D-5L instrument (p. 28). Rotterdam: EuroQol Group.

    Google Scholar 

  3. Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37(1), 53–72.

    Article  CAS  PubMed  Google Scholar 

  4. EuroQoL Group. (1990). EuroQol—A new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.

    Article  Google Scholar 

  5. Rabin, R., & De Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343.

    Article  CAS  PubMed  Google Scholar 

  6. Janssen, M. F., Pickard, A. S., Golicki, D., Gudex, C., Niewada, M., Scalone, L., et al. (2013). Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Quality of Life Research, 22(7), 1717–1727.

    Article  CAS  PubMed  Google Scholar 

  7. Kim, T. H., Jo, M. W., Lee, S. I., Kim, S. H., & Chung, S. M. (2013). Psychometric properties of the EQ-5D-5L in the general population of South Korea. Quality of Life Research, 22(8), 2245–2253.

    Article  PubMed  Google Scholar 

  8. Konig, H. H., Bernert, S., Angermeyer, M. C., Matschinger, H., Martinez, M., Vilagut, G., et al. (2009). Comparison of population health status in six European countries: results of a representative survey using the EQ-5D questionnaire. Medical Care, 47(2), 255–261.

    Article  PubMed  Google Scholar 

  9. Rawlins, M. D., & Culyer, A. J. (2004). National Institute for Clinical Excellence and its value judgments. British Medical Journal, 329(7459), 224–227.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Weinstein, M. C., Siegel, J. E., Gold, M. R., Kamlet, M. S., & Russell, L. B. (1996). Recommendations of the panel on cost-effectiveness in health and medicine. JAMA, 276(15), 1253–1258.

    Article  CAS  PubMed  Google Scholar 

  11. Sakthong, P. (2008). Measurement of clinical-effect: Utility. Journal of the Medical Association of Thailand, 91(Suppl 2), S43–52.

    PubMed  Google Scholar 

  12. Johnson, J. A., & Coons, S. J. (1998). Comparison of the EQ-5D and SF-12 in an adult US sample. Quality of Life Research, 7(2), 155–166.

    Article  CAS  PubMed  Google Scholar 

  13. 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 Economics, 14(11), 1169–1189.

    Article  PubMed  Google Scholar 

  14. McCrone, P., Patel, A., Knapp, M., Schene, A., Koeter, M., Amaddeo, F., et al. (2009). A comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia. The Journal of Mental Health Policy and Economics, 12(1), 27–31.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kularatna, S., Senanayake, S., Gunawardena, N., & Graves, N. (2019). Comparison of the EQ-5D-3L and the SF-6D (SF-36) contemporaneous utility scores in patients with chronic kidney disease in Sri Lanka: a cross-sectional survey. British Medical Journal Open, 9(2), e024854.

    Google Scholar 

  17. Pickard, A. S., De Leon, M. C., Kohlmann, T., Cella, D., & Rosenbloom, S. (2007). Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Medical Care, 45(3), 259–263.

    Article  PubMed  Google Scholar 

  18. Scalone, L., Ciampichini, R., Fagiuoli, S., Gardini, I., Fusco, F., Gaeta, L., et al. (2013). Comparing the performance of the standard EQ-5D-3L with the new version EQ-5D-5L in patients with chronic hepatic diseases. Quality of Life Research, 22(7), 1707–1716.

    Article  PubMed  Google Scholar 

  19. Kim, S. H., Kim, H. J., Lee, S. I., & Jo, M. W. (2012). Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Quality of Life Research, 21(6), 1065–1073.

    Article  PubMed  Google Scholar 

  20. Craig, B. M., Pickard, A. S., & Lubetkin, E. I. (2014). Health problems are more common, but less severe when measured using newer EQ-5D versions. Journal of Clinical Epidemiology, 67(1), 93–99.

    Article  PubMed  Google Scholar 

  21. Feng, Y., Devlin, N., & Herdman, M. (2015). Assessing the health of the general population in England: how do the three- and five-level versions of EQ-5D compare? Health Qual Life Outcomes, 13, 171.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pattanaphesaj, J., & Thavorncharoensap, M. (2015). Measurement properties of the EQ-5D-5L compared to EQ-5D-3L in the Thai diabetes patients. Health and Quality of Life Outcomes, 13, 14.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sakthong, P., Sonsa-Ardjit, N., Sukarnjanaset, P., & Munpan, W. (2015). Psychometric properties of the EQ-5D-5L in Thai patients with chronic diseases. Quality of Life Research, 24(12), 3015–3022.

    Article  PubMed  Google Scholar 

  24. Pattanaphesaj, J., Thavorncharoensap, M., Ramos-Goni, J. M., Tongsiri, S., Ingsrisawang, L., & Teerawattananon, Y. (2018). The EQ-5D-5L valuation study in Thailand. Expert Review of Pharmacoeconomics & Outcomes Research, 18(5), 551–558.

    Article  Google Scholar 

  25. Tongsiri, S., & Cairns, J. (2011). Estimating population-based values for EQ-5D health states in Thailand. Value Health, 14(8), 1142–1145.

    Article  PubMed  Google Scholar 

  26. The World Health Orgaization Quality of Life Group. (1998). The World Health Organization quality of life assessment (WHOQOL): development and general psychometric properties. Social Science & Medicine, 46(12), 1569–1585.

    Article  Google Scholar 

  27. Mahatnirundkul, S. (1998). Comparison of the WHOQOL-100 and the WHOQOL-BREF (26 items). Journal of Mental Health of Thailand, 5, 4–15.

    Google Scholar 

  28. Ware, J. E., Jr., Kosinski, M., & Keller, S. D. (2002). SF-12: how to score the SF-12 physical and mental health summary scales. Boston: Health Assessment Lab, QualityMetric Inc.

    Google Scholar 

  29. Chariyalertsak, S., Wansom, T., Kawichai, S., Ruangyuttikarna, C., Kemerer, V., & Wu, A. (2011). Reliability and validity of Thai versions of the MOS-HIV and SF12 quality of life questionnaires in people living with HIV/AIDS. Health and Quality of Life Outcomes, 9, 1–9.

    Article  Google Scholar 

  30. Phantipa, S., Vijj, K., & Win, W.-W. (2017). Assessment of health-related quality of life in Thai patients after heart surgery. Asian Biomedicine, 9(2), 203–210.

    Google Scholar 

  31. Ware, J., Kosinski, M., Turner-Bowker, D., & Gandek, B. (2002). How to score SF-12 items SF-12 v2 How to Score Version 2 of the SF-12 Health Survey, 29–38.

  32. Terwee, C. B., Bot, S. D., de Boer, M. R., van der Windt, D. A., Knol, D. L., Dekker, J., et al. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42.

    Article  PubMed  Google Scholar 

  33. Kang, E. J., & Ko, S. K. (2009). A catalogue of EQ-5D utility weights for chronic diseases among noninstitutionalized community residents in Korea. Value Health, 12(Suppl 3), S114–117.

    Article  PubMed  Google Scholar 

  34. Janssen, M. F., Birnie, E., Haagsma, J. A., & Bonsel, G. J. (2008). Comparing the standard EQ-5D three-level system with a five-level version. Value in Health, 11(2), 275–284.

    Article  PubMed  Google Scholar 

  35. Cohen, P. (1974). Regression and correlation. In Statistic in medicine. Boston: Litttle Brown and Company.

    Google Scholar 

  36. Fleiss, J. L., Levin, B., & Paik, M. C. (1981). The measurement of interrater agreement. Statistical Methods for Rates and Proportions, 2(212–236), 22–23.

    Google Scholar 

  37. Golicki, D., Niewada, M., Karlinska, A., Buczek, J., Kobayashi, A., Janssen, M. F., et al. (2015). Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ-VAS in stroke patients. Quality of Life Research, 24(6), 1555–1563.

    Article  PubMed  Google Scholar 

  38. Jia, Y. X., Cui, F. Q., Li, L., Zhang, D. L., Zhang, G. M., Wang, F. Z., et al. (2014). Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B. Quality of Life Research, 23(8), 2355–2363.

    Article  CAS  PubMed  Google Scholar 

  39. Poor, A. K., Rencz, F., Brodszky, V., Gulacsi, L., Beretzky, Z., Hidvegi, B., et al. (2017). Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L in psoriasis patients. Quality of Life Research, 26(12), 3409–3419.

    Article  PubMed  Google Scholar 

  40. Ferreira, L. N., Ferreira, P. L., Ribeiro, F. P., & Pereira, L. N. (2016). Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adults. Health and Quality of Life Outcomes, 14, 89.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Buchholz, I., Janssen, M. F., Kohlmann, T., & Feng, Y. S. (2018). A systematic review of studies comparing the measurement properties of the three-level and five-level versions of the EQ-5D. Pharmacoeconomics, 36(6), 645–661.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Yfantopoulos, J., Chantzaras, A., & Kontodimas, S. (2017). Assessment of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in psoriasis. Archives of Dermatological Research, 309(5), 357–370.

    Article  PubMed  Google Scholar 

  43. Pan, C. W., Sun, H. P., Wang, X., Ma, Q., Xu, Y., Luo, N., et al. (2015). The EQ-5D-5L index score is more discriminative than the EQ-5D-3L index score in diabetes patients. Quality of Life Research, 24(7), 1767–1774.

    Article  PubMed  Google Scholar 

  44. Greene, M. E., Rader, K. A., Garellick, G., Malchau, H., Freiberg, A. A., & Rolfson, O. (2015). The EQ-5D-5L improves on the EQ-5D-3L for health-related quality-of-life assessment in patients undergoing total hip arthroplasty. Clinical Orthopaedics and Related Research, 473(11), 3383–3390.

    Article  PubMed  Google Scholar 

  45. Buchholz, I., Thielker, K., Feng, Y. S., Kupatz, P., & Kohlmann, T. (2015). Measuring changes in health over time using the EQ-5D-3L and 5L: A head-to-head comparison of measurement properties and sensitivity to change in a German inpatient rehabilitation sample. Quality of Life Research, 24(4), 829–835.

    Article  PubMed  Google Scholar 

  46. Martí-Pastor, M., Pont, A., Ávila, M., Garin, O., Vilagut, G., Forero, C. G., et al. (2018). Head-to-head comparison between the EQ-5D-5L and the EQ-5D-3L in general population health surveys. Population Health Metrics, 16(1), 14.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Conner-Spady, B. L., Marshall, D. A., Bohm, E., Dunbar, M. J., Loucks, L., Al Khudairy, A., et al. (2015). Reliability and validity of the EQ-5D-5L compared to the EQ-5D-3L in patients with osteoarthritis referred for hip and knee replacement. Quality of Life Research, 24(7), 1775–1784.

    Article  PubMed  Google Scholar 

  48. Yfantopoulos, J. N., & Chantzaras, A. E. (2017). Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. The European Journal of Health Economics, 18(4), 519–531.

    Article  PubMed  Google Scholar 

  49. Kangwanrattanakul, K., Gross, C. R., Sunantiwat, M., & Thavorncharoensap, M. (2019). Adding two culture-specific 'bolt-on' dimensions on the Thai version of EQ-5D-5L: an exploratory study in patients with diabetes. Expert Rev Pharmacoecon Outcomes Res, 19(3), 321–329.

    Article  PubMed  Google Scholar 

  50. Kangwanrattanakul, K., & Auamnoy, T. (2019). Psychometric testing of the health-related quality of life measurement, SF-36v2, in the general population of Thailand. Expert Review of Pharmacoeconomics & Outcomes Research, 19(3), 313–320.

    Article  Google Scholar 

  51. Streiner, D. L., Norman, G. R., & Cairney, J. (2015). Health measurement scales: a practical guide to their development and use. New York: Oxford University Press.

    Book  Google Scholar 

  52. Marx, R. G., Menezes, A., Horovitz, L., Jones, E. C., & Warren, R. F. (2003). A comparison of two time intervals for test-retest reliability of health status instruments. Journal of Clinical Epidemiology, 56(8), 730–735.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was financially supported by the Research Grant of Burapha University through National Research Council of Thailand (Grant No. Rx2/2562). However, the results and opinions in this report have not been endorsed by the above funding agency or elsewhere. We would like to express our gratitude to the EuroQoL group, OPTUM and Suan Prung Psychiatric Hospital's director, Thailand for allowing us to use both EQ-5D versions, Thai SF-12v2 and WHOQOL-BREF-THAI, respectively. We would also like to thank all local village leaders and participants from the provinces of Nakhon-Srithammarat, Khon-Kaen, Chonburi, Chaing-Mai and Bangkok in Thailand who facilitated or participated in the data collection process. Special thanks to all trained interviewers for assistance with the interview process.

Funding

This work was financially supported by the Research Grant of Burapha University through National Research Council of Thailand under Grant No. Rx2/2562.

Author information

Authors and Affiliations

  1. Division of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, 169 Long-Hard Bangsaen Rd., Mueang, Chonburi, 20131, Thailand

    Krittaphas Kangwanrattanakul & Porntip Parmontree

Authors
  1. Krittaphas Kangwanrattanakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Porntip Parmontree
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Krittaphas Kangwanrattanakul (KK) was only involved in conception, study design, data collection, data analyses, interpretation and drafting of this manuscript, while Porntip Parmontree (PP) rechecked the data analyses and interpretation. However, all authors were involved in the final approval of this manuscript.

Corresponding author

Correspondence to Krittaphas Kangwanrattanakul.

Ethics declarations

Conflict of interest

All authors declare that they have no competing interests in this study.

Ethical approval

This work was approved by the Burapha University Institutional Review Board (BUU-IRB): 108/2562 before the study commenced.

Informed consent

The written consent form was obtained from each participant before the study commenced; however, they were informed to be able to withdraw from this study at any time if they felt uncomfortable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kangwanrattanakul, K., Parmontree, P. Psychometric properties comparison between EQ-5D-5L and EQ-5D-3L in the general Thai population. Qual Life Res 29, 3407–3417 (2020). https://doi.org/10.1007/s11136-020-02595-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02595-2

Keywords

Search

Navigation