Psychometric performance of the experimental EQ-HWB-9 and EQ-5D-5L in the general Chinese population

This study aimed to investigate the psychometric properties of the experimental version of the EuroQol Health and Wellbeing (EQ-HWB) nine instrument (EQ-HWB-9) (2022) version and to compare its measurement performance with that of the EQ-5D-5L in the general Chinese population.

Data were collected through a national online survey with a representative sample of the general population across different geographical regions in China (N = 1037). The survey included the EQ-HWB-9, the EQ-5D-5L, and sociodemographic information, etc. The level sum score (LSS) was analyzed as the primary outcome for comparisons between the EQ-HWB-9 and EQ-5D-5L, whereas index scores were secondary given EQ-HWB-9 used the UK pilot value set while the EQ-5D-5L used the China's. Analyses included Bland-Altman agreement, response distribution, Spearman correlations for convergent validity, and known-group validity using effect sizes and sensitivity using relative efficiency (RE).

The Bland‒Altman plot indicated good agreement between the LSS of the instruments. The ceiling effect for the EQ-HWB-9 (6.0%) was much lower than that for the EQ-5D-5L (31.2%), and no floor effect was observed. Moderate to strong correlations were shown for most overlapping items of the EQ-HWB-9 and EQ-5D-5L. In the comparison of known-group validity, both instruments demonstrated comparable performance in distinguishing between groups in terms of sex, age, health status, and disease status. For the overall health-related known groups, the EQ-HWB-9 seems to be more sensitive than the EQ-5D-5L in identifying differences.

The EQ-HWB-9 shows good psychometric performance in the general Chinese population. Compared with the EQ-5D-5L, its reduced ceiling effect and comparable known-group validity support the potential application as a complementary instrument.