Psychometric Properties of EQ-5D-3L and EQ-5D-5L in Cognitively Impaired Patients Living with Dementia

Article type: Research Article

Authors: Michalowsky, Bernhard^{a; *} | Hoffmann, Wolfgang^{a; b} | Xie, Feng^c

Affiliations: [a] German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany | [b] University Medicine Greifswald, Institute for Community Medicine (ICM), Section Epidemiology of Healthcare and Community Health, Greifswald, Germany | [c] McMaster University, Health Research Methods, Evidence and Impact (HEI), Hamilton, Canada

Correspondence: [*] Correspondence to: Bernhard Michalowsky, Ellernholzstraße 1-2, 17489 Greifswald, Germany. Tel.: +49 3834 86 75 07; E-mail: bernhard.michalowsky@dzne.de.; ORCID: 0000-0002-3425-0089

Abstract: Background:Assessing health-related quality of life in dementia poses challenges due to patients’ cognitive impairment. It is unknown if the newly introduced EQ-5D five-level version (EQ-5D-5L) is superior to the 3-level version (EQ-5D-3L) in this cognitively impaired population group. Objective:To assess the psychometric properties of the EQ-5D-5L in comparison to the EQ-5D-3L in patients living with dementia (PwD). Methods:The EQ-5D-3L and EQ-5D-5L were assessed via interviews with n = 78 PwD at baseline and three and six months after, resulting in 131 assessments. The EQ-5D-3L and EQ-5D-5L were evaluated in terms of acceptability, agreement, ceiling effects, redistribution properties and inconsistency, informativity as well as convergent and discriminative validity. Results:Mean index scores were higher for the EQ-5D-5L than the EQ-5D-3L (0.70 versus 0.64). Missing values occurred more frequently in the EQ-5D-5L than the EQ-5D-3L (8%versus 3%). Agreement between both measures was acceptable but poor in PwD with moderate to severe cognitive impairment. The index value’s relative ceiling effect decreased from EQ-5D-3L to EQ-5D-5L by 17%. Inconsistency was moderate to high (13%). Absolute and relative informativity increased in the EQ-5D-5L compared to the 3L. The EQ-5D-5L demonstrated a lower discriminative ability and convergent validity, especially in PwD with moderate to severe cognitive deficits. Conclusion:The EQ-5D-5L was not superior as a self-rating instrument due to a lower acceptability and discriminative ability and a high inconsistency, especially in moderate to severe dementia. The EQ-5D-3L had slightly better psychometric properties and should preferably be used as a self-rating instrument in economic evaluations in dementia.

Keywords: Alzheimer’s diseases, dementia, EQ-5D, patient-reported outcomes, preference-based measures, quality of life, validation

DOI: 10.3233/JAD-210421

Journal: Journal of Alzheimer's Disease, vol. 83, no. 1, pp. 77-87, 2021