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Exploring the Internal Structure of the EQ-5D Using Non-Preference-Based Methods.

You-Shan Feng1, Ruixuan Jiang2, Thomas Kohlmann1

  • 1Institute for Community Medicine, University of Greifswald, Greifswald, Germany.

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Summary
This summary is machine-generated.

Developing a psychometric score for the EQ-5D requires understanding its item structure. An internal MIMIC model best explained the EQ-5D-5L item relationships, suggesting a combination of formative and reflective indicators.

Keywords:
EQ-5D-5LMultiple Indicators Multiple Causes (MIMIC)formative measurement modelnoneconomic scoring approachesreflective measurement model

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Area of Science:

  • Health Outcomes Research
  • Psychometrics
  • Health Economics

Background:

  • Non-preference-based scores may be more appropriate for the EuroQol EQ-5D in certain applications beyond resource allocation.
  • Understanding the interrelationship of the EQ-5D's 5 dimensions is crucial for developing accurate psychometric scoring methods.

Purpose of the Study:

  • To investigate psychometrically derived approaches for clarifying the item structure of the 5-level EQ-5D (EQ-5D-5L).
  • To identify the most suitable measurement model for summarizing EQ-5D-5L data.

Main Methods:

  • Confirmatory factor analysis was used to model all 5 EQ-5D-5L items as reflective indicators.
  • Multiple Indicators Multiple Causes (MIMIC) models were employed, conceptualizing EQ-5D-5L items as formative indicators and other health scales as reflective.
  • Internal MIMIC models were tested, combining formative and reflective indicator conceptualizations for EQ-5D-5L items, with results validated across 9 diverse datasets.

Main Results:

  • Confirmatory factor analysis showed good item loadings, except for anxiety/depression.
  • External MIMIC models demonstrated poor fit and small coefficients for the Self-Care dimension.
  • The internal MIMIC model, treating Mobility, Pain/Discomfort, and Anxiety/Depression as formative and Self-Care and Usual Activities as reflective, provided the best fit.

Conclusions:

  • The structural relationships between EQ-5D-5L items were robust across different subgroups, despite some variations.
  • The findings support the need for further investigation into hybrid formative/reflective measurement models for summarizing the EQ-5D-5L.