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Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing

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Abstract

Purpose

To compare the performance of three-level EuroQol five-dimensions (EQ-5D-3L) and five-level EuroQol five-dimensions (EQ-5D-5L) among common cancer patients in urban China.

Methods

A hospital-based cross-sectional survey was conducted in three provinces from 2016 to 2018 in urban China. Patients with breast cancer, colorectal cancer, or lung cancer were recruited to complete the EQ-5D-3L and EQ-5D-5L questionnaires. Response distribution, discriminatory power (indicator: Shannon index [H′] and Shannon evenness index [J′]), ceiling effect (the proportion of full health state), convergent validity, and health-related quality of life (HRQoL) were compared between the two instruments.

Results

A total of 1802 cancer patients (breast cancer: 601, colorectal cancer: 601, lung cancer: 600) were included, with the mean age of 55.6 years. The average inconsistency rate was 4.4%. Compared with EQ-5D-3L (average: H′ = 1.100, J′ = 0.696), an improved discriminatory power was observed in EQ-5D-5L (H′ = 1.473, J′ = 0.932), especially contributing to anxiety/depression dimensions. The ceiling effect was diminished in EQ-5D-5L (26.5%) in comparison with EQ-5D-3L (34.5%) (p < 0.001), mainly reflected in the pain/discomfort and anxiety/depression dimensions. The overall utility score was 0.790 (95% CI 0.778–0.801) for EQ-5D-3L and 0.803 (0.790–0.816) for EQ-5D-5L (p < 0.001). A similar pattern was also observed in the detailed cancer-specific analysis.

Conclusions

With greater discriminatory power, convergent validity and lower ceiling, EQ-5D-5L may be preferable to EQ-5D-3L for the assessment of HRQoL among cancer patients. However, higher utility scores derived form EQ-5D-5L may also lead to lower QALY gains than those of 3L potentially in cost-utility studies and underestimation in the burden of disease.

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Abbreviations

HRQoL:

Health-related quality of life

QALYs:

Quality-adjusted life years

EQ-5D:

EuroQol five-dimensions

EQ-5D-3L:

Three-level EuroQol five-dimensions

EQ-5D-5L:

Five-level EuroQol five-dimensions

95% CI:

95% Confidence interval

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (81773521, 81402740) and the State Key Projects Specialized on Infectious Diseases (2017ZX10201201-008-002). We thank local health administrative institutes in Guangdong Province, Hunan Province, and Inner Mongolia Autonomous Region for the implementation of the survey, and all cancer patients signed the informed consent. We also appreciate all the dedicated supervisors and interviewers.

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Author notes

  1. Juan Zhu and Xin-Xin Yan have contributed equally to this work.

Authors and Affiliations

  1. Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer /Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan South Lane, Chaoyang District, Beijing, 100021, People’s Republic of China

    Juan Zhu, Xin-Xin Yan, Cheng-Cheng Liu, Hong Wang, Le Wang, Min Dai, Wanqing Chen & Ju-Fang Shi

  2. Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China

    Su-Mei Cao

  3. Hunan Office for Cancer Control and Research, Hunan Cancer Hospital, Changsha, People’s Republic of China

    Xian-Zhen Liao & Hai-Fan Xiao

  4. Inner Mongolia Center for Disease Control and Prevention, Hohhot, People’s Republic of China

    Yun-Feng Xi

  5. Cancer Hospital, Shenzhen Center, Chinese Academy of Medical Sciences, Shenzhen, People’s Republic of China

    Yong Ji

  6. Shenzhen Center for Chronic Disease Control, Shenzhen, People’s Republic of China

    Lin Lei

  7. China Center for Health Economic Research, Peking University, Beijing, People’s Republic of China

    Hai-Jing Guan

  8. Cancer Registry Office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China

    Juan Zhu & Wen-Qiang Wei

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  1. Juan Zhu
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  2. Xin-Xin Yan
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  3. Cheng-Cheng Liu
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Correspondence to Min Dai, Wanqing Chen or Ju-Fang Shi.

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Zhu, J., Yan, XX., Liu, CC. et al. Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing. Qual Life Res 30, 841–854 (2021). https://doi.org/10.1007/s11136-020-02636-w

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