Head-to-head comparisons of the distributional characteristics and measurement properties of the three-level and five-level versions of the EQ-5D-Y: a systematic review

Journal article : Review

Objective:
This systematic review compared the distributional characteristics and measurement properties of EuroQol's EQ-5D-Y-3L and EQ-5D-Y-5L instruments, using results from published head-to-head comparative studies.

Methods:
The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-COnsensus-based Standards for the selection of health Measurement INstruments (PRISMA-COSMIN) guideline. We searched 8 databases up to February 14, 2024 for studies on the measurement properties and distributional characteristics (missing data, ceiling/ floor effects, consistency, and informativity) of both EQ-5D-Y versions. Measurement quality was assessed in terms of the proportion of tests meeting COSMIN recommended criteria for reliability, validity, and responsiveness.

Results:
Eighteen studies were included. The Y-5L reduced ceiling effects by 0.8-16.5% and had a slightly higher evenness index, indicating greater informativity. Both versions showed sufficient construct validity across patient and general population samples, with the Y-5L slightly outperforming the Y-3L in known-group validity. Both the Y-3L and Y-5L versions showed sufficient test-retest reliability for mobility, pain/discomfort, and worried, sad, or unhappy, and inconsistent reliability for looking after myself and usual activities, indicating similar performance across these dimensions. The Y-5L showed better responsiveness (standardised effect size range=0.03-2.05) than Y-3L (range=0.13-0.94). In proxy-reported data, the Y-5L appears to have slightly lower test-retest reliability than the Y-3L, despite demonstrating better agreement with self-reported data.

Conclusion:
Both EQ-5D-Y versions demonstrated varying psychometric performances across the evaluated populations, with the Y-5L slightly outperforming the Y-3L in responsiveness and proxy-child agreement. The availability of the Y-5L expands the options of health-related quality of life instruments for assessing paediatric populations. Further research is needed to assess its performance across diverse populations and administrative modes.

Authors: Cheng, LJ; Schieskow, S; Chen, LA; Cheng, JY; Herdman, M

• Publication status: Published
• Publisher: Elsevier
• Journal: Value in Health
• Volume: 28
• Issue: 10
• Pages: 1574 - 1586
• Place of publication: United States
• Publication date: 2025-04-15
• Acceptance date: 2025-03-12
• DOI: 10.1016/j.jval.2025.03.020
• EISSN: 1524-4733
• ISSN: 1098-3015
• Pmid: 40246069
• Language: English
• Keywords: EQ-5D-Y; measurement properties; patient-reported outcomes; systematic review
• Subtype: Review