Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran

Nasrin Moradi; Thomas G Poder; Hossein Safari; Mohammad M Mojahedian; Hosein Ameri

doi:10.3389/fonc.2022.1052155

Psychometric properties of the EQ-5D-5L compared with EQ-5D-3L in cancer patients in Iran

Front Oncol. 2022 Dec 9:12:1052155. doi: 10.3389/fonc.2022.1052155. eCollection 2022.

Authors

Nasrin Moradi¹, Thomas G Poder^{2

3}, Hossein Safari⁴, Mohammad M Mojahedian⁵, Hosein Ameri⁶

Affiliations

¹ Department of Health Management and Economics, School of Public Health, Iran University of Medical Science, Tehran, Iran.
² Department of Management, Evaluation and Health Policy, School of Public Health, University of Montreal, Montreal, QC, Canada.
³ Centre de recherche de l'Institut universitaire en santé mentale de Montréal, CIUSSS de l'Est de l'île de Montréal, Montreal, QC, Canada.
⁴ Health Promotion Research Centre, Iran University of Medical Sciences, Tehran, Iran.
⁵ Department of Pharmacoeconomics, School of Pharmacy, Iran University of Medical Science, Tehran, Iran.
⁶ Health Policy and Management Research Center, Department of Health Management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Abstract

Background and objective: Psychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients.

Methods: Data of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability.

Results: Compared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients' characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79).

Conclusions: The 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.

Keywords: EQ-5D-3L; EQ-5D-5L; Iran; cancer patients; psychometric properties.