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The EQ-5D-5L (EQ-5D 5-level version) is a questionnaire designed to measure health-related quality of life (HRQL) for use in economic evaluations and clinical research. Developed by the EuroQol Group, it is a generic, preference-based instrument that allows for comparisons across different diseases and populations.
The EQ-5D-5L assesses health across five key dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. For each dimension, respondents rate their health on a 5-level scale (1 = no problems, 5 = extreme problems). The original version, EQ-5D-3L, included 3 levels, but was updated in 2009 to 5 levels, to improve its sensitivity to detect small changes in health.
In addition to these five dimensions, the EQ-5D-5L includes a visual analogue scale (EQ VAS), where respondents rate their overall health on a vertical 0-100 scale (0 = worst imaginable health, 100 = best imaginable health).
To ensure consistency in health technology assessments, the National Institute for Health and Care Excellence (NICE) recommends the EQ-5D as the preferred measure for HRQL in economic evaluations. Many other international health agencies and regulatory bodies also accept EQ-5D-based utility values for decision-making.
How is the EQ-5D-5L administered?
The EQ-5D-5L can be administered in various formats, including paper-based questionnaires, digital devices, interviews, and proxy reports. Different versions are available to accommodate these administration modes. In most cases, NICE recommends that:
- Patients self-report their health status whenever possible, as they are the most reliable source for their own experience.
- Alternative administration methods may be appropriate if self-reporting is not feasible due to the condition (e.g., cognitive impairment or severe illness).
- Proxy responses should be provided by a close caregiver if the patient is unable to complete the questionnaire.
- EQ-5D health state values (i.e., utility values from value sets) should be derived from a representative sample of the general population, rather than from patients themselves, ensuring that utility scores reflect societal preferences for health states.
How are health utilities estimated with the EQ-5D-5L?
Responses to the EQ-5D-5L are converted into a 5-digit identifier, representing a specific health state (e.g., 11111 denotes no problems in any dimension). This identifier can be used to generate a utility value based on published value sets. The value sets allow a utility value to be placed on all 3,125 possible EQ-5D health states. Country-specific value sets are available based on general population preferences.
NICE does not currently recommend using the UK EQ-5D-5L value set. Instead, they advise converting EQ-5D-5L responses into EQ-5D-3L values using a process called ‘mapping’. This approach ensures consistency across economic evaluations. More information and guidance on NICE-recommended mapping methods are available here.
In summary, the EQ-5D-5L provides a standardized method for assessing health outcomes and generating utility values. However, for NICE submissions and certain economic evaluations, mapping to EQ-5D-3L values may be required.
If you’d like an informal chat with one of our experts about our capabilities in utility estimation, get in touch at info@vitaccess.com.
