Position statement on use of the EQ-5D-5L value set for England (updated October 2019)

Content under review

We're updating this page following the publication of our new methods, processes and topic selection manuals. Our previous manuals still apply to evaluations that started before 1 February 2022. The new manuals apply to evaluations that began after this date.

  1. Since 2008, our preferred measure of health-related quality of life in adults has been EQ‑5D. For most of that time, there has been only 1 version of the descriptive system, EQ‑5D‑3L. In this version, respondents rate their degree of impairment in different health domains using 3 response levels (no problems, some problems and extreme problems). The EuroQol Group has created a new descriptive system, EQ‑5D‑5L, with 5 response levels (no problems, slight problems, moderate problems, severe problems and extreme problems). EQ‑5D‑5L was designed to be more sensitive than EQ‑5D‑3L.

  2. Our current guide to the methods of technology appraisal 2013 states that data collected using the EQ‑5D‑5L descriptive system may be used for reference-case analyses. When the guide was written, there was no value set for EQ‑5D‑5L from which to derive utilities. Our methods guide (section 5.3.12) states that: ‘Until an acceptable valuation set for the EQ‑5D‑5L is available, the validated mapping function to derive utility values for the EQ‑5D‑5L from the existing EQ‑5D (‑3L) may be used (available from http://www.euroqol.org)’.

  3. An EQ‑5D‑5L value set for England has been published (Devlin et al. 2018). Independent quality assurance (Hernandez Alava et al. 2018) and reports from 4 independent experts raised concerns about the quality and reliability of the data collected in the valuation study, and the methods used to model these data. Accordingly, we've chosen not to use the EQ-5D-5L value set for England published by Devlin et al (2018). The English valuation study was one of the first to be carried out anywhere in the world. Since then the international standard valuation study protocol has been improved and additional quality control methods introduced.

  4. The following statement applies to all guidance-producing programmes at NICE that use cost-utility analyses.

Position statement

  1. We do not recommend using the EQ-5D-5L value set for England published by Devlin et al. (2018). Companies, academic groups and others preparing evidence submissions for NICE should use the 3L value set for reference-case analyses.

  2. If data were gathered using the EQ‑5D‑5L descriptive system, utility values in reference-case analyses should be calculated by mapping the 5L descriptive system data onto the 3L value set. If analyses use data gathered using both EQ‑5D‑3L and EQ‑5D‑5L descriptive systems, the 3L value set should be used to derive all utility values, with 5L mapped onto 3L where needed.

  3. The mapping function developed by van Hout et al. (2012) should be used for reference-case analyses, for consistency with the current guide to the methods of technology appraisal (even though several mapping functions are available; Hernandez Alava et al. 2017).

  4. We support sponsors of prospective clinical studies continuing to use the 5L version of the EQ‑5D descriptive system to collect data on quality of life.

  5. We are committed to working with the Department of Health and Social Care, and other key stakeholders, to ensure that a 5L value set of an acceptable quality to allow adoption in our methods becomes available. EuroQol is commissioning a new 5L valuation study for England using an updated international standard protocol. We plan to review our policy on EQ-5D-5L when this new study is complete.

Expert advice

  1. In 2019 we commissioned 4 independent experts to provide advice on the EQ-5D-5L value set for England. This was funded by an unrestricted grant from EuroQol. To inform the experts EuroQol analysed interviewer effects in the valuation study for England. If you'd like a copy of the clarification questions and responses from the expert advice process please email us.

Expert evaluation reports

References

Devlin N, Shah K, Feng Y et al. (2018) Valuing health-related quality of life: an EQ 5D 5L value set for England. Health Economics 27(1): 7-22

Hernandez Alava M, Wailoo A, Pudney S (2017) Methods for mapping between the EQ 5D 5L and the 3L. NICE Decision Support Unit report [online; accessed October 2019]

Hernandez Alava M, Wailoo A, Pudney S (2018) Quality review of a proposed EQ-5D-5L value set for England. EEPRU report [online; accessed October 2019]

Van Hout B, Janssen M, Feng Y et al. (2012) Interim scoring for the EQ 5D 5L: Mapping the EQ 5D 5L to EQ 5D 3L value sets. Value in Health, 15: 708-15.