IDEAS home Printed from
   My bibliography  Save this article

What Determines the Shape of an EQ-5D Index Distribution?


  • David Parkin
  • Nancy Devlin
  • Yan Feng


Background . EQ-5D-3L index scores in patient and general populations typically have a nonnormal distribution, divided into 2 distinct groups. It is important to understand to what extent this is determined by the way that the EQ-5D-3L index is constructed rather than by the true distribution of ill health. Objective. This paper examines the determinants of the “2 groups†distribution pattern and the extent to which this pattern is attributable either to the EQ-5D-3L classification system used to create health state profiles or to the weights applied to profiles. Methods. Data from the English NHS PROMs program (hip and knee replacements and varicose vein and hernia repairs) and from a study of 2 chronic conditions (asthma and angina) were used to compare the distributions of EQ-5D-3L index scores with distributions from which weights have been stripped; profile data decomposed into their constituent dimensions and levels; a condition-specific index; and using weights from different countries, based on both time tradeoff and visual analogue scale. Results. The EQ-5D-3L classification system generates differences between patients with the same condition in respect of dimensions that are mainly observed at level 2 or 3. The weights commonly used to calculate the index exacerbate this grouping by placing a larger weight on level 3 observations, generating a noticeable gap in index scores between the groups. Conclusions. Analyzing EQ-5D profile data enables a better understanding of the resulting distribution of EQ-5D scores. The distinctive shape observed for these distributions is the result of both the classification system and the weights applied to it.

Suggested Citation

  • David Parkin & Nancy Devlin & Yan Feng, 2016. "What Determines the Shape of an EQ-5D Index Distribution?," Medical Decision Making, , vol. 36(8), pages 941-951, November.
  • Handle: RePEc:sae:medema:v:36:y:2016:i:8:p:941-951
    DOI: 10.1177/0272989X16645581

    Download full text from publisher

    File URL:
    Download Restriction: no

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item

    Other versions of this item:

    References listed on IDEAS

    1. Rowen, D & Brazier, J & Roberts, J, 2008. "Mapping SF-36 onto the EQ-5D index: how reliable is the relationship?," MPRA Paper 29831, University Library of Munich, Germany.
    2. David Parkin & Nigel Rice & Nancy Devlin, 2010. "Statistical Analysis of EQ-5D Profiles: Does the Use of Value Sets Bias Inference?," Medical Decision Making, , vol. 30(5), pages 556-565, September.
    3. John Brazier & Jennifer Roberts & Aki Tsuchiya & Jan Busschbach, 2004. "A comparison of the EQ‐5D and SF‐6D across seven patient groups," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 873-884, September.
    4. Nancy J. Devlin & David Parkin & John Browne, 2010. "Patient‐reported outcome measures in the NHS: new methods for analysing and reporting EQ‐5D data," Health Economics, John Wiley & Sons, Ltd., vol. 19(8), pages 886-905, August.
    5. Shaheen, Rubina & Lindholm, Lars, 2006. "Quality of life among pregnant women with chronic energy deficiency in rural Bangladesh," Health Policy, Elsevier, vol. 78(2-3), pages 128-134, October.
    6. Caitlyn T. Wilke & A. Simon Pickard & Surrey M. Walton & Joern Moock & Thomas Kohlmann & Todd A. Lee, 2010. "Statistical implications of utility weighted and equally weighted HRQL measures: an empirical study," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 101-110, January.
    7. Juan Manuel Ramos-Goni & Oliver Rivero-Arias, 2011. "eq5d: A command to calculate index values for the EQ-5D quality-of-life instrument," Stata Journal, StataCorp LP, vol. 11(1), pages 120-125, March.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Brendan Mulhern & Yan Feng & Koonal Shah & Mathieu F. Janssen & Michael Herdman & Ben Hout & Nancy Devlin, 2018. "Comparing the UK EQ-5D-3L and English EQ-5D-5L Value Sets," PharmacoEconomics, Springer, vol. 36(6), pages 699-713, June.
    2. Cubi-Molla, P. & de Vries, J. & Devlin, N., 2013. "A Study of the Relationship Between Health and Subjective Well-being in Parkinson's Disease Patients," Research Papers 000108, Office of Health Economics.
    3. Nancy J. Devlin & Koonal K. Shah & Yan Feng & Brendan Mulhern & Ben van Hout, 2018. "Valuing health‐related quality of life: An EQ‐5D‐5L value set for England," Health Economics, John Wiley & Sons, Ltd., vol. 27(1), pages 7-22, January.
    4. Mathieu F. Janssen & Gouke J. Bonsel & Nan Luo, 2018. "Is EQ-5D-5L Better Than EQ-5D-3L? A Head-to-Head Comparison of Descriptive Systems and Value Sets from Seven Countries," PharmacoEconomics, Springer, vol. 36(6), pages 675-697, June.
    5. Nancy Devlin & John Brazier & A. Simon Pickard & Elly Stolk, 2018. "3L, 5L, What the L? A NICE Conundrum," PharmacoEconomics, Springer, vol. 36(6), pages 637-640, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Feng, Y. & Parkin, D. & Devlin, N., 2012. "Assessing the Performance of the EQ-VAS in the NHS PROMs Programme," Research Papers 000165, Office of Health Economics.
    2. Jeff Round & Annie Hawton, 2017. "Statistical Alchemy: Conceptual Validity and Mapping to Generate Health State Utility Values," PharmacoEconomics - Open, Springer, vol. 1(4), pages 233-239, December.
    3. Raymond Oppong & Billingsley Kaambwa & Jacqueline Nuttall & Kerenza Hood & Richard Smith & Joanna Coast, 2013. "The impact of using different tariffs to value EQ-5D health state descriptions: an example from a study of acute cough/lower respiratory tract infections in seven countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 197-209, April.
    4. SeungJin Bae & SooOk Lee & Eun Bae & Sunmee Jang, 2013. "Korean Guidelines for Pharmacoeconomic Evaluation (Second and Updated Version)," PharmacoEconomics, Springer, vol. 31(4), pages 257-267, April.
    5. Ning Gu & Chris Bell & Marc Botteman & Xiang Ji & John Carter & Ben Hout, 2012. "Estimating Preference-Based EQ-5D Health State Utilities or Item Responses from Neuropathic Pain Scores," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(3), pages 185-197, September.
    6. Knott, R. & Lorgelly, P. & Black, N. & Hollingsworth, B., 2016. "Differential item functioning in the EQ-5D: An exploratory analysis using anchoring vignettes," Health, Econometrics and Data Group (HEDG) Working Papers 16/14, HEDG, c/o Department of Economics, University of York.
    7. Brazier, JE & Yang, Y & Tsuchiya, A, 2008. "A review of studies mapping (or cross walking) from non-preference based measures of health to generic preference-based measures," MPRA Paper 29808, University Library of Munich, Germany.
    8. Ian M. McCarthy, 2015. "Putting the Patient in Patient Reported Outcomes: A Robust Methodology for Health Outcomes Assessment," Health Economics, John Wiley & Sons, Ltd., vol. 24(12), pages 1588-1603, December.
    9. Hirsch Ruchlin & Ralph Insinga, 2008. "A Review of Health-Utility Data for Osteoarthritis," PharmacoEconomics, Springer, vol. 26(11), pages 925-935, November.
    10. Nils Gutacker & Andrew Street, 2015. "Multidimensional performance assessment using dominance criteria," Working Papers 115cherp, Centre for Health Economics, University of York.
    11. Nils Gutacker & Andrew Street, 2018. "Multidimensional performance assessment of public sector organisations using dominance criteria," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 13-27, February.
    12. Tsuchiya, Aki & Brazier, John & Roberts, Jennifer, 2006. "Comparison of valuation methods used to generate the EQ-5D and the SF-6D value sets," Journal of Health Economics, Elsevier, vol. 25(2), pages 334-346, March.
    13. Ayse Kuspinar & Nancy Mayo, 2014. "A Review of the Psychometric Properties of Generic Utility Measures in Multiple Sclerosis," PharmacoEconomics, Springer, vol. 32(8), pages 759-773, August.
    14. Michela Meregaglia & Amanda Whittal & Elena Nicod & Michael Drummond, 2020. "‘Mapping’ Health State Utility Values from Non-preference-Based Measures: A Systematic Literature Review in Rare Diseases," PharmacoEconomics, Springer, vol. 38(6), pages 557-574, June.
    15. Marco DiBonaventura & Lance Richard & Maya Kumar & Anna Forsythe & Natalia M Flores & Margaret Moline, 2015. "The Association between Insomnia and Insomnia Treatment Side Effects on Health Status, Work Productivity, and Healthcare Resource Use," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-14, October.
    16. Efthymiadou, Olina & Mossman, Jean & Kanavos, Panos, 2019. "Health related quality of life aspects not captured by EQ-5D-5L: Results from an international survey of patients," Health Policy, Elsevier, vol. 123(2), pages 159-165.
    17. C. Rubio-Terrés & J. Soria & P. Morange & J. Souto & P. Suchon & J. Mateo & N. Saut & D. Rubio-Rodríguez & J. Sala & A. Gracia & S. Pich & E. Salas, 2015. "Economic Analysis of Thrombo inCode, a Clinical–Genetic Function for Assessing the Risk of Venous Thromboembolism," Applied Health Economics and Health Policy, Springer, vol. 13(2), pages 233-242, April.
    18. Marisa Santos & Monica A. C. T. Cintra & Andrea L. Monteiro & Braulio Santos & Fernando Gusmão-filho & Mônica Viegas Andrade & Kenya Noronha & Luciane N. Cruz & Suzi Camey & Bernardo Tura & Paul Kin, 2016. "Brazilian Valuation of EQ-5D-3L Health States," Medical Decision Making, , vol. 36(2), pages 253-263, February.
    19. Marieke Krol & Elly Stolk & Werner Brouwer, 2014. "Predicting productivity based on EQ-5D: an explorative study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(5), pages 465-475, June.
    20. Clara Mukuria & Donna Rowen & Sue Harnan & Andrew Rawdin & Ruth Wong & Roberta Ara & John Brazier, 2019. "An Updated Systematic Review of Studies Mapping (or Cross-Walking) Measures of Health-Related Quality of Life to Generic Preference-Based Measures to Generate Utility Values," Applied Health Economics and Health Policy, Springer, vol. 17(3), pages 295-313, June.

    More about this item


    EQ-5D; health-related quality of life; health state preferences; utilities; valuations;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:36:y:2016:i:8:p:941-951. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.