Once Bitten Twice Shy: Thinking Carefully Before Adopting the EQ-5D-5L

Abstract

The EQ-5D-3L version has long been the preferred measure of health-related utility estimates for the National Institute for Health and Care Excellence (NICE). Over time, concerns about the EQ-5D-3L have been raised, focusing on its sensitivity to changes in health state, ceiling effects, and the uneven distribution of values across the states. In response, the EuroQol group developed an alternative five-level version, the EQ-5D-5L, and in 2013 NICE recommended the 5L version for use in reference case analyses. Subsequently, the new version of the instrument has been widely adopted in clinical research and for economic evaluation, typically at the expense of the EQ-5D-3L version. Yet this begs the question and assumes the 5L version is simply a minor change to the 3L version that can be adopted without consideration of its own merits. It is right to ask, however, whether it is more than just a minor variant of the 3L. The 3L version has been tested and validated in a wide range of patient groups-the same cannot yet be said for the 5L version. Additionally, the 3L version was adopted at a time when reliable alternative measures of outcome were scarce-the same cannot be said now. Here I argue that analysts and reimbursement authorities such as NICE should exercise caution and consider the whole range of alternative tools before adopting the 5L version as the reference case.

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT

“…The EQ-5D is the standard measure used in economic evaluation, although there is currently some uncertainty about which specific measure to choose of the new EuroQol-5 Dimensions, five-level version (EQ-5D-5L) and the older, more established, EuroQol-5 Dimensions, three-level version (EQ-5D-3L). [184][185][186][187] The EQ-5D has been used in nursing home settings, [188][189][190][191] but there is some concern about whether or not health measures such as the EQ-5D capture the outcomes important to those coming towards the end of life. 192,193 However, alternative generic measures for those in the later stages of the life-course 194 are relatively new and untested, although they are included in the National Institute for Health and Care Excellence (NICE) recommendations for assessing social care interventions 195 and recommended in other settings for long-term care.…”

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

“…The psychometric properties of the threelevel version have been well established [34][35][36][37][38][39][40]. Any reluctance of using the more recently developed five-level version might come in part from limited experience and evidence for validity, reliability or responsiveness in different populations [41]. This review summarized published evidence on the psychometric properties of the EQ-5D-5L, which has been investigated in a broad array of countries, populations and contexts in the past decade.…”

NICE and the EQ-5D-5L: Ten Years Trouble

“…Publication of the final (peer-reviewed) version of the value set in August 2017 [3] triggered a flurry of editorials and commentaries [4][5][6]. Contributors to the debate varied in their perspectives of whether or not NICE should recommend the use of the 5L value set, but all were broadly supportive of a 'pause' [4] and the 'understandable care' [5] and 'caution' [6] of NICE's approach [7].…”