title: Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
abstract: OBJECTIVE
  This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure.
  
  
  METHODS
  EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument's sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions.
  
  
  RESULTS
  Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording 'slight-moderate-severe' problems, with anchors of 'no problems' and 'unable to do' in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states.
  
  
  CONCLUSIONS
  A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
authors.affiliation: Insight Consulting and Research, 08301 Mataró, Spain. michael.herdman@insightcr.com
authors.forename: M
authors.initials: M
authors.lastname: Herdman
authors.forename: C
authors.initials: C
authors.lastname: Gudex
authors.forename: A
authors.initials: A
authors.lastname: Lloyd
authors.forename: Mf
authors.initials: M
authors.lastname: Janssen
authors.forename: P
authors.initials: P
authors.lastname: Kind
authors.forename: D
authors.initials: D
authors.lastname: Parkin
authors.forename: G
authors.initials: G
authors.lastname: Bonsel
authors.forename: X
authors.initials: X
authors.lastname: Badia
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D005260:Female; D017144:Focus Groups; D006305:Health Status Indicators; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010147:Pain Measurement; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D015203:Reproducibility of Results; D012648:Self Care; D013030:Spain; D006113:United Kingdom