Generic measure of health related quality of life

The EQ-5D-5L is a validated generic instrument for measuring patients’ general health status and is an extended version of the EQ-5D-3L. Two levels were added to this improved version in order to reduce the ceiling effect and increase the sensitivity of the 3-level version. The content of this tool is split into two parts: the EQ-5D descriptive system and the EQ visual analogue scale (VAS).

The first consists of 5 questions assessing the patient’s mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ VAS evaluates the patient’s general state of health. The instrument has been used in various medical disciplines, including orthopedics, oncology and pneumology.


The 5-level version of the EQ-5D is a generic instrument for assessing patients’ health. In orthopedics, it has been used in patients with upper extremity disorders 1, low back pain 2 and osteoarthritis 3. Colorectal cancer patients have been evaluated with the EQ-5D-5L in oncology 4, as have patients with interstitial lung disease in the field of pneumology 5.

Items - Dimensions - Completion time

The tool is divided into the EQ-5D descriptive system, consisting of 5 questions, which are to be answered by selecting 1 of 5 responses per question, and the EQ VAS with a single score of 0–100. 6 The EQ-5D descriptive system covers five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ VAS assesses general health on a scale of 100 (“the best health you can imagine”) to 0 (“the worst health you can imagine”). The patient is asked to answer the questions based on how he or she is feeling that day. There is no information in the literature about how long it takes to answer the EQ-5D-5L, but there being a low number of items, a short completion time of 3–4 minutes can be expected.


Each of the five questions can be answered by selecting 1 of 5 health levels: no problems, slight problems, moderate problems, severe problems and extreme problems. After all items have been answered, a unique health status is calculated by combining the number of the level selected for each question into a single number, for example 12445.

There are a total of 3,125 (i.e., 55) health statuses possible. Skipped items are allocated a score of “9.” The EQ VAS score is stated separately as the number the patient selected (e.g., 73). If the VAS is skipped, a score of “999” is allocated.

From the unique health status, a single summary index value is generated using a general population-based value set. The scoring concept is based on the time trade-off method (patients decide how many years of symptom-free life they would equate to 10 years of life in their current state of health). 7

Score interpretation

The patient’s health status can be represented with an EQ-5D single summary index value and a VAS score. A value of 1 indicates the best possible health status, whereas lower scores are linked with health deficits and scores below 0 can be interpreted as “worse than death.”

The EQ-5D-5L has been validated in several languages. 8 9 10
No license fees are charged for noncommercial use (such as for randomized controlled trials, cohort studies, case–control studies, cross-sectional studies and clinical use). For commercial use (e.g., by pharmaceutical companies and medical device manufacturers), fees apply. 11
The EQ-5D-5L is widely used internationally and has a good reputation and acceptance. Moreover, being quick to complete, the tool is easy to implement in the clinical routine. In comparison with the 3-level version of the EQ-5D, the ceiling effect is significantly lower 12.
Although lower than in the 3-level version of the tool, the ceiling effect persists. 13

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  1. Grobet, Cecile, et al. “Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review.” Archives of orthopaedic and trauma surgery 138.7 (2018): 953-961.
  2. Ye, Ziping, Lihua Sun, and Qi Wang. “A head-to-head comparison of EQ-5D-5 L and SF-6D in Chinese patients with low back pain.” Health and quality of life outcomes 17.1 (2019): 1-11.
  3. 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.
  4. Huang, Weidong, et al. “Assessing health-related quality of life of patients with colorectal cancer using EQ-5D-5L: a cross-sectional study in Heilongjiang of China.” BMJ open 8.12 (2018): e022711.
  5. Szentes, Boglárka Lilla, et al. “Quality of life assessment in interstitial lung diseases: a comparison of the disease-specific K-BILD with the generic EQ-5D-5L.” Respiratory research 19.1 (2018): 1-10.
  6. https://euroqol.org/publications/user-guides/
  7. 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.
  8. Rand-Hendriksen, Kim, et al. “Less is more: cross-validation testing of simplified nonlinear regression model specifications for EQ-5D-5L health state values.” Value in Health 20.7 (2017): 945-952.
  9. Keeley, Thomas, et al. “A qualitative assessment of the content validity of the ICECAP-A and EQ-5D-5L and their appropriateness for use in health research.” PloS one 8.12 (2013): e85287.
  10. Ludwig, Kristina, J-Matthias Graf von der Schulenburg, and Wolfgang Greiner. “German value set for the EQ-5D-5L.” Pharmacoeconomics 36.6 (2018): 663-674.
  11. https://euroqol.org/support/documents/eq-5d-user-license-policy/
  12. 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.
  13. Hinz, Andreas, et al. “The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population.” Quality of Life Research 23.2 (2014): 443-447.

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