EQ-5D
EuroQol Five-Dimension Health Status Questionnaire · Also known as: EQ-5D-3L, EQ-5D-5L, EuroQol
The EQ-5D is a standardized, preference-based health utility measure developed by the EuroQol Group in 1990. It combines a descriptive health profile (five dimensions, three or five response levels) with a visual analog scale to quantify overall health status. The instrument has become essential for health economics, clinical trials, and cost-effectiveness analysis worldwide.
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When to use it
The EQ-5D is the standard instrument for economic evaluation in health technology assessment (HTA), reimbursement decisions, and clinical trials requiring cost-effectiveness data. It is appropriate for adult populations across all health conditions and is less suitable for very young children (age < 4) or patients unable to self-report. Use condition-specific preference measures when condition-specific sensitivity is critical.
Strengths & limitations
- Preference-weighted scoring enables direct health economic analysis and QALY calculations without additional instruments
- Brief administration (1–2 minutes) allows use in large trials and population surveys
- Extensive cross-country validation with standardized preference weights available for 50+ countries and regions
- Simple five-dimension structure makes results intuitive and interpretable to patients and clinicians
- Widely accepted by health technology assessment bodies and insurance regulators for reimbursement decisions
- The five dimensions may not capture all relevant health concepts; condition-specific measures often provide greater sensitivity
- Preference weights are population-dependent; using one country's weights in another population introduces bias
- EQ-5D-3L has ceiling effects (many respondents at '11111', perfect health); EQ-5D-5L addresses this but has less extensive validation
- VAS is subjective and subject to anchoring effects; less reliable than utility index for ranking health states
Frequently asked
What is the difference between EQ-5D-3L and EQ-5D-5L?
EQ-5D-3L has three response levels per dimension (no problem, some, severe); EQ-5D-5L has five (no, slight, moderate, severe, extreme). The 5L version is more sensitive to subtle health changes and reduces ceiling effects. However, 3L has more extensive international validation and longer history. Choose 5L for new studies; use 3L when comparing to historical data.
Why are EQ-5D preference weights country-specific?
Preference weights reflect how a country's general population values different health states. A British preference set may weight pain differently than a Spanish one due to cultural, healthcare, and language differences. Using incorrect country weights introduces systematic bias in cost-effectiveness conclusions and reimbursement decisions.
How is a QALY calculated from EQ-5D?
QALYs = EQ-5D utility score × time period in years. If a patient has an EQ-5D of 0.8 for one year, that is 0.8 QALYs gained. In cost-effectiveness research, cost per QALY gained is calculated to compare treatment options; thresholds like £20,000–30,000 per QALY guide reimbursement decisions in the UK.
Can negative EQ-5D scores occur, and what do they mean?
Yes; some health states are valued by society as worse than death, yielding negative utility scores. For example, some severe disease combinations might score -0.15. This reflects societal preference judgments and is used in economic models, though it can be conceptually challenging.
Sources
- Rabin, R., & de Charro, F. (2001). EQ-5D: a measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343. DOI: 10.3109/07853890109002087 ↗
- EuroQol Group. (1990). EuroQol—a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208. link ↗
- Herdman, M., Gudex, C., Lloyd, A., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research, 20(10), 1727–1736. DOI: 10.1007/s11136-011-9903-x ↗
How to cite this page
ScholarGate. (2026, June 3). EuroQol Five-Dimension Health Status Questionnaire. ScholarGate. https://scholargate.app/en/health-measurement/eq-5d
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