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Understanding the composite dimensions of the EQ-5D: An experimental approach

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  • McDonald, Rebecca
  • Mullett, Timothy L.
  • Tsuchiya, Aki

Abstract

The EQ-5D(-5L) includes two composite dimensions: “Pain or Discomfort” (P/D) and “Anxiety or Depression” (A/D), which involves an inherent ambiguity. Little is known about how these composite dimensions are interpreted across contexts where (i) individuals self-report their own health; and (ii) individuals value stylised health states. We detail the nature of the ambiguity and present experimental evidence from two large online surveys (n = 1007 and n = 1415). In one survey, individuals reported both their current health and their health at the time they felt the worst because of their health. In the other, they valued stylised EQ-5D states using Discrete Choice Experiments with duration as an attribute. In both surveys, participants were randomised into treatments in which the presentation of one of the composite dimensions was altered, or a control. Our results suggest (1) In self-report, use of the composite dimensions differs across the dimensions, with P/D used mainly to report Pain, but A/D used mainly to mean the more severe component of Anxiety and Depression. (2) In valuation, Pain was perceived to be worse than Discomfort at the same level, and Depression was perceived to be worse than Anxiety at the same level. (3) In valuation, the composite dimension P/D was interpreted to mean Pain, whilst the composite dimension A/D was interpreted to lie between Anxiety and Depression. We conclude that care must be taken when interpreting responses to existing health (or wellbeing) descriptive systems that rely on composite dimensions, and that caution should be applied when designing new ones.

Suggested Citation

  • McDonald, Rebecca & Mullett, Timothy L. & Tsuchiya, Aki, 2020. "Understanding the composite dimensions of the EQ-5D: An experimental approach," Social Science & Medicine, Elsevier, vol. 265(C).
    • Handle: RePEc:eee:socmed:v:265:y:2020:i:c:s0277953620305426
    DOI: 10.1016/j.socscimed.2020.113323
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    References listed on IDEAS

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    1. Brendan Mulhern & Richard Norman & Deborah J. Street & Rosalie Viney, 2019. "One Method, Many Methodological Choices: A Structured Review of Discrete-Choice Experiments for Health State Valuation," PharmacoEconomics, Springer, vol. 37(1), pages 29-43, January.
    2. Brazier, John & Rowen, Donna & Tsuchiya, Aki & Yang, Yaling & Young, Tracy A., 2011. "The impact of adding an extra dimension to a preference-based measure," Social Science & Medicine, Elsevier, vol. 73(2), pages 245-253, July.
    3. Bansback, Nick & Hole, Arne Risa & Mulhern, Brendan & Tsuchiya, Aki, 2014. "Testing a discrete choice experiment including duration to value health states for large descriptive systems: Addressing design and sampling issues," Social Science & Medicine, Elsevier, vol. 114(C), pages 38-48.
    4. Aki Tsuchiya & Nick Bansback & Arne Risa Hole & Brendan Mulhern, 2019. "Manipulating the 5 Dimensions of the EuroQol Instrument: The Effects on Self-Reporting Actual Health and Valuing Hypothetical Health States," Medical Decision Making, , vol. 39(4), pages 380-392, May.
    5. Bansback, Nick & Brazier, John & Tsuchiya, Aki & Anis, Aslam, 2012. "Using a discrete choice experiment to estimate health state utility values," Journal of Health Economics, Elsevier, vol. 31(1), pages 306-318.
    6. Brendan Mulhern & Richard Norman & Koonal Shah & Nick Bansback & Louise Longworth & Rosalie Viney, 2018. "How Should Discrete Choice Experiments with Duration Choice Sets Be Presented for the Valuation of Health States?," Medical Decision Making, , vol. 38(3), pages 306-318, April.
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