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Med Decis Making. 2019 May;39(4):379-392. doi: 10.1177/0272989X19851049. Epub 2019 Jun 4.

Manipulating the 5 Dimensions of the EuroQol Instrument: The Effects on Self-Reporting Actual Health and Valuing Hypothetical Health States.

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School of Health and Related Research, University of Sheffield, Sheffield, UK.
Department of Economics, University of Sheffield, Sheffield, UK.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, New South Wales, Australia.


Background. The EQ-5D instrument has 5 dimensions. This article reports on the effects of manipulating a) the order in which the 5 dimensions are presented (appearing first v. last), b) splitting of the composite dimensions ("pain or discomfort" and "anxiety or depression"), and c) removing or "bolting off" 1 of the 5 EQ-5D dimensions at a time. The effects were examined in 2 contexts: 1) self-reporting health and 2) health state valuations. Methods. Three different types of discrete choice experiments (DCE) including a duration attribute were designed. An online survey with 12 subtypes, each with 10 DCE tasks, was designed and completed by 2494 members of the UK general public. Results. Of the 3 manipulations in the self-reporting context, only b) splitting anxiety or depression had a significant effect. In the health state valuation context, b) splitting level 5 pain or discomfort (relative to pain) and splitting level 5 anxiety or depression (relative to anxiety) had significant effects as did c) bolting off dimensions. Conclusions. We find that the values given to certain health dimensions are sensitive to the way in which it is described and the other health dimensions presented. Of particular interest is the effect of splitting composite dimensions: a given EQ-5D(-5L) profile may mean different things depending on whether the profile is used to self-report one's health or to value hypothetical states, so that the health state values of EQ-5D(-5L) in population tariffs may not correspond to the states that patients self-report themselves in.


EQ-5D; bolt-offs; composite dimensions; dimension order; health state valuation; self-reported health


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