EQ-5D-5L: health-status assessment

What this assessment is

The EQ-5D-5L is a brief adult measure of current health status.

Today is the timeframe.

It has two parts. The first records the level of difficulty in five health dimensions. The second is a visual scale on which the person rates their overall health today.

The five dimension ratings form a health-state profile. That profile can also be converted to a health-utility index with a value set developed for a named country or region.

The profile, utility index, and visual rating are different results. Do not treat them as three versions of the same score.

Keep them separate.

The EQ-5D-5L does not diagnose a disease or mental health condition.

Who it was designed for

The EuroQol Group introduced the five-level adult version in 2009. It was designed to describe health across diseases, treatments, and populations.

The development study found that five response levels improved descriptive detail and reduced the ceiling seen with the older three-level EQ-5D.

The adult form is used in clinical studies, population surveys, outcome monitoring, and economic evaluation. Youth versions are separate instruments and should not be substituted for the adult form.

The standard report comes from the patient. Proxy versions exist for situations in which another person reports the patient's health, but respondent type must remain clear.

How it is administered

The person describes their health today.

The assessment takes only a few minutes. It can be completed on paper, by interview, or through an approved digital mode.

Use one validated language version and the matching instructions. Small wording or layout changes can alter how a person answers a very short measure.

The five-level version must not be scored with the response structure from the EQ-5D-3L. The two versions describe health states differently.

Version must match.

What it measures

The descriptive system covers five dimensions:

• mobility
• self-care
• usual activities
• pain or discomfort
• anxiety or depression

Each dimension has five ordered levels of reported difficulty. One selected level from each dimension creates a five-digit health-state profile.

Digits describe health.

Five dimensions with five levels produce 3,125 possible profiles.

The separate EQ VAS records the person's overall judgment of health on a 0-to-100 scale. It can reflect aspects of health that are not fully represented by the five dimensions.

The measure is broad by design. It gives a compact health description rather than a detailed symptom assessment.

How scoring works

Record the selected level for each of the five dimensions in the standard order. Keep the five digits together as a health-state profile.

Do not add the digits. Their sum is not an EQ-5D-5L score.

They form a profile.

When an index is needed, apply a published value set for the relevant country or region. The value set assigns a preference weight to each possible health state.

Index values usually have 1 as the value for full health in the descriptive system. Some health states can receive values below 0, meaning they were valued below dead in that preference study. The exact minimum and the spacing between values differ across value sets.

Indexes are contextual.

Always report which value set was used. An index calculated with one country's values cannot be assumed to match an index calculated with another's.

Name the value set.

Report the EQ VAS separately from the index. The VAS ranges from 0 to 100 and records the person's own overall health rating.

The EuroQol value-set guidance should be followed for the population and analysis. Do not replace a missing country value set with an unlabelled algorithm.

How to interpret EQ-5D-5L results

Start with the five-dimension profile. It shows where the person reports difficulty today.

The index summarizes that profile using preferences from a defined population. A higher index generally represents a health state valued more favorably by that population.

The EQ VAS is the person's own overall rating. It can differ from the index because it reflects a personal judgment rather than the weights in a population value set.

There are no universal clinical bands for good, moderate, or poor health. Economic studies may use index differences for a specific purpose, but those rules are not diagnostic thresholds.

It is not diagnostic.

When tracking change, keep the EQ-5D version, language, respondent type, mode, value set, and timing consistent.

What the results cannot tell you

The EQ-5D-5L cannot diagnose the cause of a reported problem.

Its anxiety or depression dimension is not a mental health diagnosis. Its pain or discomfort dimension cannot identify an injury or pain mechanism.

A profile showing no reported problems does not prove perfect health. The person may have symptoms or concerns outside the five dimensions.

The index cannot show what an individual personally values. It applies preferences estimated from a population study.

The result cannot choose a treatment, establish fitness for work, or decide eligibility for care without other evidence.

Evidence and limitations

The EuroQol description of the EQ-5D-5L explains the two-part structure and the change from three to five levels.

The measure is short, consistent, and useful across conditions. It also supports health-economic analysis when a suitable value set exists.

Brevity limits detail. The five dimensions may miss fatigue, cognition, relationships, sleep, and other concerns that matter to a particular patient.

Ceiling effects can still occur when many people select the best level in every dimension. A disease-specific measure may detect changes that the EQ-5D-5L misses.

Value sets are not interchangeable. Results can change when analysts use a different country's preferences or a crosswalk instead of a direct five-level value set.

Use the EQ-5D-5L as a compact health profile. Pair it with clinical information and more focused measures when the question requires detail.

Add detail when needed.