Preliminary findings of an investigation into the relationship between national culture and EQ-5D value sets

Qual Life Res. 2010 Oct;19(8):1145-54. doi: 10.1007/s11136-010-9678-5. Epub 2010 May 23.


Background: Despite the growing importance of the EQ-5D descriptive system as a basis for the valuation of QALYs in cost-utility analysis, for most countries, there are no EQ-5D value sets. Researchers and policy makers wishing to use the EQ-5D descriptive system in a country for which there is no value set are advised to use one from a nearby or 'similar' population. Factors other than geographic proximity can affect the relative values of EQ-5D states.

Objective: This study explores the links between national culture and EQ-5D value sets.

Method: Rank correlation analysis is used to explore relationships between the relative values of a set of EQ-5D states and dimensions of national culture. The latter are taken from Hofstede's framework which operationalizes national culture in five dimensions.

Results: For the data currently available (countries for which EQ-5D value sets and scores on dimensions of culture both exist), moderate and strong correlations were found between the culture dimension of power distance and individualism and the EQ-5D dimensions of pain/discomfort and anxiety/depression. Moderate correlations were also observed between the cultural dimension of masculinity and the EQ-5D dimensions of self care, usual activities and pain/discomfort. Uncertainty avoidance correlates with the EQ-5D dimension of anxiety/depression.

Discussion: The correlation patterns observed are generally consistent with a priori expectations based on the nature of the dimensions of culture and the EQ-5D model. This analysis demonstrates the potential of national culture in providing insight into the drivers of the relative values of EQ-5D dimensions for different countries and in informing decisions about which EQ-5D value sets to use in situations where one does not exist.

MeSH terms

  • Cultural Characteristics*
  • Gender Identity
  • Health Status
  • Humans
  • Mental Health
  • Models, Theoretical
  • Quality-Adjusted Life Years*
  • Reference Values
  • Surveys and Questionnaires