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Measurement Properties of the EQ-5D-5L and EQ-5D-3L in Six Commonly Diagnosed Cancers

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Abstract

Background

This study aimed to compare the measurement properties of the EQ-5D-3L (3L) and EQ-5D-5L (5L) in cancer patients.

Methods

A consecutive sample of inpatients with lung, breast, colorectal, liver, gastric, or thyroid cancer were interviewed using the 3L, 5L, and Functional Assessment of Cancer Therapy–General (FACT-G) questionnaires, and a subgroup was invited to complete the 3L and 5L again. Kappa and intraclass correlation coefficient were used to assess test–retest reliability, and Spearman’s correlation between the EQ-5D and FACT-G was evaluated to assess convergent validity. Comparison of subgroups defined using Eastern Cooperative Oncology Group status and cancer stage were performed to assess known-group validity and discriminatory power using the F-statistic and area under the receiver-operating characteristics curve. All analyses were also performed for each subgroup of cancer patients.

Results

A total of 416 cancer patients completed the baseline questionnaire and 90 patients also completed the follow-up survey after 2 days. Ceiling effects were smaller in 5L (10.1%) than in 3L (17.8%). The test–retest reliability and convergent validity of the 5L were slightly better than those of the 3L. Both the 3L and 5L showed known-group validity; however, the 5L index showed better discriminatory power. Similar trends were found in the six types of cancers.

Conclusion

In general, 5L appears to have better measurement properties than 3L for measuring the health-related quality of life of cancer patients. While both the 3L and 5L are suitable, 5L should be preferable to 3L for use in cancer outcomes research.

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References

  1. Pickard AS, Jiang R, Lin H-W, Rosenbloom S, Cella D. Using patient-reported outcomes to compare relative burden of cancer: EQ-5D and functional assessment of cancer therapy-general in eleven types of cancer. Clin Ther. 2016;38(4):769–77.

    Article  Google Scholar 

  2. Wijeysundera HC, Sara FZ, William W, Maria B. Conversion of the Seattle Angina Questionnaire into EQ-5D utilities for ischemic heart disease: a systematic review and catalog of the literature. Clinicoecon Outcomes Res. 2014;6:253–68.

    Article  Google Scholar 

  3. Nina K, Sandra E, Vinding GR, Gregor J, Anders ML. A systematic literature review to compare quality of life in psoriasis with other chronic diseases using EQ-5D-derived utility values. Patient Relat Outcome Meas. 2015;6:167–77.

    Google Scholar 

  4. Mlynczak K, Wojcik A, Dobrowolska I, Jaskowiak K, Niewada M, Golicki D. Systematic review of health state utilities based on the Eq-5d in studies of lymphomas. Value Health. 2016;19(7):A593.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Tsuchiya A, Ikeda S, Ikegami N, Nishimura S, Sakai I, Fukuda T, et al. Estimating an EQ-5D population value set: the case of Japan. Health Econ. 2002;11(4):341–53.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. Bansback N, Tsuchiya A, Brazier J, Anis A. Canadian valuation of EQ-5D health states: preliminary value set and considerations for future valuation studies. PLoS One. 2012;7(2):e31115.

    Article  CAS  Google Scholar 

  10. Rawlins MD, Culyer AJ. National Institute for Clinical Excellence and its value judgments. BMJ. 2004;329(7459):224–7.

    Article  Google Scholar 

  11. Janssen MF, Birnie E, Haagsma JA, Bonsel GJ. Comparing the standard EQ-5D three-level system with a five-level version. Value Health. 2008;11(2):275–84.

    Article  Google Scholar 

  12. 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.

    Article  CAS  Google Scholar 

  13. Pattanaphesaj J, Thavorncharoensap M. Measurement properties of the EQ-5D-5L compared to EQ-5D-3L in the Thai diabetes patients. Health Qual Life Outcomes. 2015;13(1):14.

    Article  Google Scholar 

  14. Jia Y, Cui F, Li L, Zhang D, Zhang G, Wang F, et al. Comparison between the EQ-5D-5L and the EQ-5D-3L in patients with hepatitis B. Qual Life Res. 2014;23(8):2355–63.

    Article  CAS  Google Scholar 

  15. Scalone L, Ciampichini R, Fagiuoli S, Gardini I, Fusco F, Gaeta L, et al. 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. 2013;22(7):1707–16.

    Article  Google Scholar 

  16. Golicki D, Niewada M, Karlińska A, Buczek J, Kobayashi A, Janssen M, et al. Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res. 2015;24(6):1555–63.

    Article  Google Scholar 

  17. Poór AK, Rencz F, Brodszky V, Gulácsi L, Beretzky Z, Hidvégi B, et al. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L in psoriasis patients. Qual Life Res. 2017;26(12):3409–19.

    Article  Google Scholar 

  18. Kim SH, Jo MW, Lee JW, Lee HJ, Kim JK. Validity and reliability of EQ-5D-3L for breast cancer patients in Korea. Health Qual Life Outcomes. 2015;13:203.

    Article  Google Scholar 

  19. Lang HC, Chuang L, Shun SC, Hsieh CL, Lan CF. Validation of EQ-5D in patients with cervical cancer in Taiwan. Support Care Cancer. 2010;18(10):1279–86.

    Article  Google Scholar 

  20. Pickard DAS, Wilke CT, Lin HW, Lloyd A. Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics. 2007;25(5):365–84.

    Article  Google Scholar 

  21. Ding H, Yang Y, Cheng X, Dong P, Yan X, Hu G, et al. Reliability and validity of EQ-5D-3L and FACT in Beijing’s patients with cancer and precancerosis. Tumor. 2017;9:953–9.

    Google Scholar 

  22. van Dongen-Leunis A, Redekop WK, Uyl-de Groot CA. Which questionnaire should be used to measure quality-of-life utilities in patients with acute leukemia? An evaluation of the validity and interpretability of the EQ-5D-5L and preference-based questionnaires derived from the EORTC QLQ-C30. Value Health. 2016;19(6):834–43.

    Article  Google Scholar 

  23. Bulamu NB, Chen G, Ratcliffe J, Schloite A, Bright T, Watson DI. Health-related quality of life associated with Barrett’s Esophagus and cancer. World J Surg. 2019;43(6):1554–62.

    Article  Google Scholar 

  24. Lee CF, Ng R, Luo N, Wong NS, Yap YS, Lo SK, et al. The English and Chinese versions of the five-level EuroQoL Group’s five-dimension questionnaire (EQ-5D) were valid and reliable and provided comparable scores in Asian breast cancer patients. Support Care Cancer. 2013;21(1):201–9.

    Article  Google Scholar 

  25. Thompson AJ, Turner AJ. A comparison of the EQ-5D-3L and EQ-5D-5L. Pharmacoeconomics. 2020;38(6):575–91.

    Article  Google Scholar 

  26. Buchholz I, Janssen MF, Kohlmann T, Feng Y-S. A systematic review of studies comparing the measurement properties of the three-level and five-level versions of the EQ-5D. PharmacoEconomics. 2018;36(6):645–61.

    Article  Google Scholar 

  27. Pickard AS, De Leon MC, Kohlmann T, Cella D, Rosenbloom S. Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med Care. 2007;45(3):259–63.

    Article  Google Scholar 

  28. Kim SH, Kim HJ, Lee S-I, Jo M-W. Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Qual Life Res. 2012;21(6):1065–73.

    Article  Google Scholar 

  29. Heilongjiang Provincial Bureau of Statistics. Heilongjiang Statistical Yearbook. Peking: China Statistics Press, 2018. https://www.hlj.gov.cn/zwfb/system/2019/06/17/010902375.shtml.

  30. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, Mcfadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–56.

    Article  CAS  Google Scholar 

  31. Liu GG, Wu H, Li M, Gao C, Luo N. Chinese time trade-off values for EQ-5D health states. Value Health. 2014;17(5):597–604.

    Article  Google Scholar 

  32. 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.

    Article  Google Scholar 

  33. Wan C, Meng Q, Tang X, Zhang C, Luo J, Zhang X. Valuation for Chinese version of FACT-G in cancer patients. J Pract Oncol. 2006;21(1):77–80.

    Google Scholar 

  34. Cohen J. Chi square tests for goodness of fit and contingency tables. Stat Power Anal Behav Sci. 1988;2:215–71.

    Google Scholar 

  35. Vickrey BG, Hays RD, Genovese BJ, Myers LW, Ellison GW. Comparison of a generic to disease-targeted health-related quality-of-life measures for multiple sclerosis. J Clin Epidemiol. 1997;50(5):557–69.

    Article  CAS  Google Scholar 

  36. Luo N, Johnson JA, Shaw JW, Coons SJ. 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. 2009;47(1):53–60.

    Article  CAS  Google Scholar 

  37. Janssen MF, Bonsel GJ, Luo N. Is EQ-5D-5L better than EQ-5D-3L? A head-to-head comparison of descriptive systems and value sets from seven countries. PharmacoEconomics. 2018;36:675–97.

    Article  Google Scholar 

  38. Wongpakaran N, Wongpakaran T, Wedding D, Gwet KL. A comparison of Cohen’s Kappa and Gwet’s AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples. BMC Med Res Methodol. 2013;13:61.

    Article  Google Scholar 

  39. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.

    Article  CAS  Google Scholar 

  40. Shrout PE. Measurement reliability and agreement in psychiatry. Stat Methods Med Res. 1998;7(3):301–17.

    Article  CAS  Google Scholar 

  41. Yfantopoulos JN, Chantzaras AE. Validation and comparison of the psychometric properties of the EQ-5D-3L and EQ-5D-5L instruments in Greece. Eur J Health Econ. 2016;18(4):1–13.

    Google Scholar 

Download references

Acknowledgements

The authors are especially grateful to the participants who have suffered from cancer and have never given up.

Author information

Author notes

  1. Xueyun Zeng, Mingjie Sui, and Bo Liu contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. School of Health Management, Harbin Medical University, Harbin, 150086, China

    Xueyun Zeng, Mingjie Sui, Bo Liu, Rui Liu, Juan Xu, Jinjin Yang & Weidong Huang

  2. Department of Medical Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, 150086, China

    Hongbin Yang

  3. National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore

    Rachel Lee-Yin Tan & Nan Luo

  4. The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China

    Erwei Zheng

  5. Tianjin Health Development Research Center, No. 94 Guizhou Road, Heping District, Tianjin, 300070, China

    Chunyu Liu

  6. Southern University of Science and Technology Hospital, Shenzhen, 518110, China

    Hongjuan Yu

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  1. Xueyun Zeng
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Corresponding authors

Correspondence to Weidong Huang or Hongjuan Yu.

Ethics declarations

Funding

The current study is funded by the National Social Science Foundation of China (Grant numbers 71974048, 71503062) and the China Medical Board (CMB-19-308).

Conflict of interest

Xueyun Zeng, Mingjie Sui, Bo Liu, Hongbin Yang, Rui Liu, Rachel Lee-Yin Tan, Juan Xu, Erwei Zheng, Jinjin Yang, Chunyu Liu, Weidong Huang, Hongjuan Yu, and Nan Luo declare there are no conflicts of interest in relation to this manuscript.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards and were approved by the Regional Ethical Committee, Harbin Medical University.

Consent to participate

All individuals provided the informed consent in current study.

Consent for publication

Not applicable.

Availability of data and code

The data and code are available from the corresponding author upon reasonable request.

Author contributions

XZ and MS participated in the design of the study and drafted the manuscript. WH, HYu, and NL participated in the design of the study, and critically drafted and revised the manuscript. HYang, RL, EZ, JY, and CL collected and processed the data. RT helped to draft the manuscript. BL conceived the idea, and critically revised the manuscript. JX helped with data analysis and edited the revised version of the manuscript. All authors read and approved the final version of the manuscript.

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Zeng, X., Sui, M., Liu, B. et al. Measurement Properties of the EQ-5D-5L and EQ-5D-3L in Six Commonly Diagnosed Cancers. Patient 14, 209–222 (2021). https://doi.org/10.1007/s40271-020-00466-z

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