Can The EQ-5D Detect Meaningful Change? A Systematic Review

Abstract

Background: The EQ-5D is one of the most frequently used, generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required. Objective: This study systematically reviewed and synthesized evidence on the responsiveness of the EQ-5D to detect meaningful change in health status for clinical research and economic evaluations. Methods: We searched the EuroQol website, PubMed, PsychINFO, and EconLit databases to identify studies published in English from the inception of the EQ-5D until August 15, 2014 using keywords that were related to responsiveness. Studies that used only the EQ-VAS were excluded from the final analysis. Narrative synthesis was conducted to summarize evidence on the responsiveness of the EQ-5D by conditions or physiological functions. Results: Of 1401 studies, 145 were included in the narrative synthesis and categorized into 19 categories for 56 conditions. The EQ-5D was found to be responsive in 25 conditions (45 %) with the magnitude of responsiveness varying from small to large depending on the condition. There was mixed evidence of responsiveness in 27 conditions (48 %). Only four conditions (7 %) (i.e., alcohol dependency, schizophrenia, limb reconstruction, and hearing impairment) were identified where the EQ-5D was not responsive. Conclusion: The EQ-5D is an appropriate measure for economic evaluation and health technology assessment in conditions where it has demonstrated evidence of responsiveness. In conditions with mixed evidence of responsiveness, researchers should consider using the EQ-5D with other condition-specific measures to ensure appropriate estimates of effectiveness. These conditions should be a main focus for future research using the new EQ-5D version with five response levels.