EuroQol (EQ-5D-5L) Validity in Assessing the Quality of Life in Adults With Asthma: Cross-Sectional Study

Original Paper 

Gimena Hernandez1,2,3, MD, MPH Olatz Garin1,3,4, MPH, PhD Alexandra L Dima5, PhD Angels Pont1,3, BSc Marc Martí Pastor1,2,3, MD, MPH Jordi Alonso1,3,4, MD, PhD Eric Van Ganse5,6, MD, PhD Laurent Laforest6, MD, PhD Marijn de Bruin7, PhD Karina Mayoral1,2, MPH Vicky Serra-Sutton3,8, PhD Montse Ferrer1,2,3, MD, PhD ASTRO-LAB Group

1Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain

2Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

3Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain

4Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain

5Health Services and Performance Research, Université Claude Bernard Lyon 1, Lyon, France

6Pharmaco-Epidemiology Lyon, Lyon, France

7Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom

8Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain

Corresponding Author:

Montse Ferrer, MD, PhD

Health Services Research Group


Background: The EuroQol-5 Dimension (EQ-5D), developed in 1990, is a most widely used generic tool to measure the health-related quality of life (HRQoL) and considered suitable for patients with asthma. In 2009, the EuroQol Group developed a new EQ-5D version to overcome limitations related to its consistently reported high ceiling effect. To enhance the sensitivity for assessing the HRQoL in further patient populations, the number of responses of EQ-5D was increased from 3 to 5 levels (EQ-5D-5L). Moreover, the availability of well-defined requirements for its Web-based administration allows EQ-5D-5L use to monitor the HRQoL in electronic health (eHealth) programs. No study has evaluated the metric properties of the new EQ-5D-5L in patients with asthma yet.

Objective: This study aims to examine the distribution, construct validity, and reliability of the new EQ-5D-5L questionnaire administered online to adults with asthma.

Methods: We evaluated patients with asthma (age: 18-40 years) from a primary care setting in France and England, who self-completed the EQ-5D-5L questionnaire online. The inclusion criteria were persistent asthma defined as >6 months of prescribed inhaled corticosteroids and long-acting beta-agonists or inhaled corticosteroids alone during the 12 months prior to inclusion. The EQ-5D index was obtained by applying the English preference value set for the new EQ-5D-5L and the French 3L-5L crosswalk value set. Both value sets produced single preference-based indices ranging from 1 (best health state) to negative values (health states valued as worse than death), where 0=death, allowing the calculation of quality-adjusted life years. Responses to dimensions and index distribution, including ceiling and floor effects, were examined. The construct validity was assessed by comparing the means of known groups by analyses of variance and calculation of effect sizes.

Results: Of 312 patients answering the baseline Web-based survey, 290 completed the EQ-5D-5L (93%). The floor effect was null, and the ceiling effect was 26.5% (74/279). The mean EQ-5D-5L index was 0.88 (SD 0.14) with the English value set and 0.83 (SD 0.19) with the French 3L-5L crosswalk value set. In both indices, large effect sizes were observed for known groups defined by the Asthma Control Questionnaire (1.06 and 1.04, P<.001). Differences between extreme groups defined by chronic conditions (P=.002 and P=.003 for the English value set and French 3L-5L crosswalk value set, respectively), short-acting beta-agonists (SABAs) canisters in the last 12 months (P=.02 and P=.03), or SABA use during the previous 4 weeks (P=.03 and P=.01) were of moderate magnitude with effect sizes around 0.5.

Conclusions: The new EQ-5D-5L questionnaire has an acceptable ceiling effect, a good construct validity based on the discriminant ability for distinguishing among health-related known groups, and high reliability, supporting its adequacy for assessing the HRQoL in patients with asthma. EQ-5D-5L completion by most Web-based respondents supports the feasibility of this administration form.

J Med Internet Res 2019;21(1):e10178                  PDF

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Editor: Juan C. Ivancevich, MD

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