title: Do health preferences contradict ordering of EQ-5D labels?
abstract: OBJECTIVE
  The aim of this study was to test whether the ordering of item labels in EQ-5D instruments disagrees with the preferences of US adults.
  
  
  METHODS
  A preference inversion occurs when "worse" health along a scale or score is preferred. As a sub-study of the 2013 United States Measurement and Valuation of Health Study, we tested for 33 EQ-5D preference inversions using paired comparisons with unique samples of 50 or more US adults, aged 18 or older. Specifically, we tested whether health preferences contradicted ordering of EQ-5D labels.
  
  
  RESULTS
  The EQ-5D-3L and EQ-5D-Y item labels had no significant preference inversions. The EQ-5D-5L version had preference inversions between Levels 4 and 5. For example, 30 out of 59 respondents (51 %) preferred being "extremely" over "severely anxious or depressed," contrary to the ordering of labels for that item.
  
  
  CONCLUSIONS
  Preference inversions between Levels 4 and 5 on the EQ-5D-5L were tested and confirmed; therefore, valuation studies may find that Levels 4 and 5 have the same value. To mitigate such inversions, labels could be revised or a 4-level version could be considered.
authors.affiliation: Health Outcomes and Behavior, Moffitt Cancer Center, University of South Florida, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, USA, benjamin.craig@moffitt.org.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Craig
authors.forename: A Simon
authors.initials: AS
authors.lastname: Pickard
authors.forename: Kim
authors.initials: K
authors.lastname: Rand-Hendriksen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D014481:United States; D055815:Young Adult