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EuroQoL EQ-5D Questionnaire

The EuroQoL EQ-5D questionnaire is a brief utility index designed to measure health-related quality of life and health preferences. The Panel on CostEffectiveness in Health and Medicine recommends the use of societal or community preferences to calculate quality-adjusted life years (QALYs) for the reference case analysis in cost-effectiveness analyses. Preference-based health state classification systems, or ‘utility indices,’ represent a class of survey instruments recommended as suitable for providing these community preferences for reference-case analyses. While the mechanisms for creating scoring functions vary for different utility indices, these indices all consist of a descriptive health survey on which the respondent describes his or her state of health on multiple domains. The survey is then scored to produce a summary measure, which represents an average preference score of the population in which the scoring algorithm was derived. The preference scores calculated by this class of instruments are suitable for use in QALY calculations to be used in any analysis combining morbidity and mortality into one summary measure of population health, for example, decision analyses and costutility analyses.

When completing the EQ-5D, a respondent rates his or her health on five domains; these responses are then scored to provide a community utility. The survey also has a visual analog scale (VAS) on which the respondent rates his or her health, providing the respondent's own preference for health in addition to a community-based utility score. The EQ-5D's brevity and the availability of translations in numerous different languages have contributed to this instrument's popularity; a recent systematic review by Rasanen and colleagues found that almost half (47%) of all studies reporting QALY calculations based on valid assessment techniques used the EQ-5D for the utility values in QALY calculations.

The Survey

The EuroQoL (a contraction of ‘European Quality of Life’) Group, a multidisciplinary, international group of researchers, developed the EQ-5D; this survey has been in the public domain since 1990. The survey was designed to be a self-administered, simple, generic measure of health. Although originally designed to be used alongside other measures to allow comparability across settings, the EQ-5D has also been used as a stand-alone measure of health.

The EQ-5D is currently available in 60 different official language versions, and additional language translations are in development. The U.S. English language version is shown in Figure 1. The survey consists of one question for each of five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each domain has three levels: no limitations in function, some limitation, and extreme limitations or unable to function, giving a total of 243 different combinations of responses.

The EQ-5D has been shown to be valid in a number of populations and health conditions. In general populations, significant proportions of respondents had the highest score possible on the EQ-5D index (a ceiling effect), although in comparison to another utility index, the SF-6D, the EQ-5D index may have fewer people achieving the lowest possible score (a floor effect).

In addition to using the EQ-5D index to derive health utilities for QALY calculations, the survey has been used as a descriptive measure of health status, for example, to describe the health of populations or the impact of health care interventions such as surgical procedures or medical therapies. The index score can be used to provide a summary score across all five domains of health measured, and the function of individuals on the five separate domains of health has also been reported. While the index score gives a summary measure of preference or value for the person's state of health, a preference score alone does not state why one state of health is valued more or less than another. The five-question index describes the function of the respondent on the domains of health represented in the survey, allowing exploration of the specific domain differences that may explain differences in the overall score.

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