EQ-5D-3L
Generic measure of health-related quality of life
The EQ-5D-3L is a validated generic measure instrument for patients health status which was developed in 1990 by the EuroQol Group. It consists of two components: the EQ-5D descriptive system represents a tool of 5 questions assessing mobility, self-care, usual activities, pain/discomfort and anxiety/depression meanwhile a visual analogue scale measures the general health state. It has already been used in many studies assessing general quality of life of several patient groups. The field of application of the EQ-5D includes various medical disciplines, including studies from orthopedics, oncology, geriatrics and cardiology. Compared to it’s extension – the EQ-5D-5L – the 3 level version showed weaknesses in form of ceiling effects and less informativity.
Indication
The EQ-5D-3L represents a generic measure instrument for patients health status and is not a disease-specific tool.1, 2 The instrument can be used for diseases in various medical disciplines.3 There are studies in orthopedics that are exemplarily including patient groups with fragility fractures and spondyloarthritis, oncologic studies with cancer patients, cardiologic patient groups with heart failure and validation studies with elderly patients in general.4, 5, 6
Items - Dimensions - Completion time
The tool can be divided in two parts: on the one hand the EQ-5D descriptive system consisting of 5 questions with 3 response options each. Only one answer can be selected per question. The second part is the EQ-VAS, a visual analogue scale with an numeric equivalent from 0-100.
The EQ-5D descriptive system consists of five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Additionally the visual analogue scale assesses patients general health state with 100 as the best and 0 as the worst imaginable health state. The patient should answer the questions depending how he or she is feeling today.
There is no information in literature about how long it takes to answer the EQ-5D-3L, but a short completion time can be expected due to the low number of items. We estimate a completion time of approximately 2-3min.
Scoring method
Each of the five dimensions can be answered by picking one of three health levels: level 1 is connected with no problems, level two is linked with some problems and level 3 depicts extreme problems in the certain dimension. After answering all five items a unique health state is defined by combining the levels of each dimension in number, for example 11223. There is a total number of 243 possible health states (35). Missing values are coded as “9”. The score of the EQ-VAS is stated separately as a number (for example 73). A missing value in the VAS is coded as “999”.
Out of the unique health state a single summary index can be generated by using a general population based value-set, where a score of 1 indicates the best possible health state whereas lower scores are linked with health deficits and scores <0 can be interpreted as “worse than sudden death”. The scoring concept bases on the time-trade-off method (patients have to decide how many years of symptom-free-life they would equal to 10 years of lifetime in the particular health state).7
Score interpretation
Patients health status can be represented with EQ-5D-single-summary-index and VAS-score. A single summary index of 1 is coding the best possible health score. Lower scores are connected with health status deficits.
In 1990 the instrument has been developed by the EuroQol-Group (Rotterdam, Netherlands). The questionnaire can be accessed via the EuroQol-Group homepage.12
No license fees are charged for non-commercial use (such as randomized controlled trials, cohort studies, case–control studies and cross-sectional studies or clinical use). For commercial use, fees will apply (e.g. pharmaceutical company, medical device manufacturers).13
The EQ-5D-3L is widely used internationally and has a good reputation and acceptance. Moreover the tool is easy to implement in clinical routine due to its small extent.
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References
Svedbom, Axel, et al. “Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS.” Quality of Life Research 27.3 (2018): 707-716.
Parsons, N., et al. “Outcome assessment after hip fracture: is EQ-5D the answer?.” Bone & joint research 3.3 (2014): 69-75.
Tsang, Helen Hoi Lun, et al. “Psychometric validation of the EuroQoL 5-dimension (EQ-5D) questionnaire in patients with spondyloarthritis.” Arthritis research & therapy 21.1 (2019): 1-14.
Kim, Seon Ha, et al. “Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea.” Quality of Life Research 21.6 (2012): 1065-1073.
Mangen, Marie-Josée J., et al. “Quality of life in community-dwelling Dutch elderly measured by EQ-5D-3L.” Health and quality of life outcomes 15.1 (2017): 1-6.
Kularatna, Sanjeewa, et al. “Comparison of contemporaneous responses for EQ-5D-3L and Minnesota Living with Heart Failure; a case for disease specific multiattribute utility instrument in cardiovascular conditions.” International journal of cardiology 227 (2017): 172-176.
Greiner, Wolfgang, et al. “Validating the EQ-5D with time trade off for the German population.” The European journal of health economics 6.2 (2005): 124-130.
Conner-Spady, Barbara L., et al. “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 (2015): 1775-1784.
Yfantopoulos, John N., and Athanasios E. Chantzaras. “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 (2017): 519-531.
Hurst, N. P., et al. “Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D).” British journal of rheumatology 36.5 (1997): 551-559.
Obradovic, Marko, Arun Lal, and Hiltrud Liedgens. “Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus Short Form-6 dimension (SF-6D) questionnaire in chronic pain.” Health and quality of life outcomes 11.1 (2013): 1-9.
https://euroqol.org/
https://euroqol.org/support/documents/eq-5d-user-license-policy/
Janssen, M. F., et al. “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 (2013): 1717-1727.
Kim, Seon Ha, et al. “Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea.” Quality of Life Research 21.6 (2012): 1065-1073.