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

Research output: Contribution to journalComment/debate

Original languageEnglish
Pages (from-to)641-643
Number of pages3
Issue number6
Early online date1 Mar 2018
DateAccepted/In press - 19 Feb 2018
DateE-pub ahead of print - 1 Mar 2018
DatePublished (current) - 1 Jun 2018


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.

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