Further evidence on EQ-5D-5L preference inversion: a Brazil/U.S. collaboration
Benjamin M Craig1, Andréa L Monteiro2, Michael Herdman3
1Department of Economics, University of South Florida, Tampa, FL, USA. benjamin.craig@iahpr.org.
Summary
Preference inversions, where worse health is preferred, were confirmed in English EQ-5D-5L surveys and found more frequently in Portuguese versions, particularly in anxiety/depression measures.
Area of Science:
- Health Economics
- Psychometrics
- Linguistic Analysis
Background:
- Preference inversion occurs when respondents prefer a worse health state over a better one.
- The EQ-5D-5L is a widely used measure of health-related quality of life.
- Anecdotal evidence suggested higher inversion rates in the Portuguese EQ-5D-5L due to translation nuances.
Purpose of the Study:
- To confirm preference inversions in the English EQ-5D-5L.
- To investigate preference inversions in the Portuguese EQ-5D-5L.
- To explore the impact of translation on health state valuations.
Main Methods:
- Surveys administered to 740 respondents in the U.S. and Brazil.
- Included EQ-5D-3L and EQ-5D-5L questionnaires.
- Paired comparisons assessed preference inversions across five EQ-5D domains.
Main Results:
- English respondents showed significant inversions primarily in the Anxiety/Depression (AD) domain (45%).
- Portuguese respondents exhibited higher inversion rates across all domains, especially AD (65%).
- Specifically, 65% of Brazilian respondents preferred 'extremely' anxious/depressed over 'severely' anxious/depressed.
Conclusions:
- Confirms previous findings of preference inversions in the English EQ-5D-5L.
- Portuguese version of EQ-5D-5L required relabeling due to higher inversion rates.
- Highlights the importance of cross-disciplinary collaboration in developing and translating health measures.
