title: Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study.
abstract: OBJECTIVE
  The aim of this study was to assess the measurement properties of the 5-level classification system of the EQ-5D (5L), in comparison with the 3-level EQ-5D (3L).
  
  
  METHODS
  Participants (n = 3,919) from six countries, including eight patient groups with chronic conditions (cardiovascular disease, respiratory disease, depression, diabetes, liver disease, personality disorders, arthritis, and stroke) and a student cohort, completed the 3L and 5L and, for most participants, also dimension-specific rating scales. The 3L and 5L were compared in terms of feasibility (missing values), redistribution properties, ceiling, discriminatory power, convergent validity, and known-groups validity.
  
  
  RESULTS
  Missing values were on average 0.8% for 5L and 1.3% for 3L. In total, 2.9% of responses were inconsistent between 5L and 3L. Redistribution from 3L to 5L using EQ dimension-specific rating scales as reference was validated for all 35 3L-5L-level combinations. For 5L, 683 unique health states were observed versus 124 for 3L. The ceiling was reduced from 20.2% (3L) to 16.0% (5L). Absolute discriminatory power (Shannon index) improved considerably with 5L (mean 1.87 for 5L versus 1.24 for 3L), and relative discriminatory power (Shannon Evenness index) improved slightly (mean 0.81 for 5L versus 0.78 for 3L). Convergent validity with WHO-5 was demonstrated and improved slightly with 5L. Known-groups validity was confirmed for both 5L and 3L.
  
  
  CONCLUSIONS
  The EQ-5D-5L appears to be a valid extension of the 3-level system which improves upon the measurement properties, reducing the ceiling while improving discriminatory power and establishing convergent and known-groups validity.
authors.affiliation: Department of Medical Psychology and Psychotherapy, Erasmus MC, Erasmus University, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. mf.bas.janssen@gmail.com
authors.forename: M F
authors.initials: MF
authors.lastname: Janssen
authors.forename: A Simon
authors.initials: AS
authors.lastname: Pickard
authors.forename: Dominik
authors.initials: D
authors.lastname: Golicki
authors.forename: Claire
authors.initials: C
authors.lastname: Gudex
authors.forename: Maciej
authors.initials: M
authors.lastname: Niewada
authors.forename: Luciana
authors.initials: L
authors.lastname: Scalone
authors.forename: Paul
authors.initials: P
authors.lastname: Swinburn
authors.forename: Jan
authors.initials: J
authors.lastname: Busschbach
mesh_terms: D000203:Activities of Daily Living; D016002:Discriminant Analysis; D005240:Feasibility Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010361:Patients / Q000523:psychology; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires