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The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L

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Abstract

Aim

To analyze the association between ceiling effects on the EQ-5D 5L and morbidity in a general population sample.

Methods

We used a cross-sectional sample of the German general population (n = 5007) to describe the frequency of health state “11111” and “no problems”-answers on the five single dimensions stratified by the number of diseases for which participants utilized health care during the last 6 months. For the five single dimensions we also used specific criteria to analyze their discriminative ability. A logit-model was applied for a multivariate analysis of ceiling effects.

Results

31% of participants reported the health state “11111.” This percentage strongly decreased with increasing morbidity, down to 4.9% if four or more diseases were present. The dimensions “mobility,” “usual activities,” and “pain/discomfort” showed good discriminative abilities. The dimensions “anxiety/depression” and “self -care” were able to discriminate between different levels of morbidity, but nevertheless showed strong ceiling effects, in particular “self-care.”

Conclusion

When analyzing ceiling effects of the EQ-5D 5L, one has to draw attention to morbidity since high proportions of participants indicating the best health state might result from being healthy regarding the dimensions assessed by the EQ-5D, in particular in general population datasets.

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Authors and Affiliations

  1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Alexander Konnopka & Hans-Helmut Koenig

Authors
  1. Alexander Konnopka
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  2. Hans-Helmut Koenig
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Corresponding author

Correspondence to Alexander Konnopka.

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Conflict of interest

The authors have no conflicts of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.

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Konnopka, A., Koenig, HH. The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L. Qual Life Res 26, 2079–2084 (2017). https://doi.org/10.1007/s11136-017-1551-3

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  • DOI: https://doi.org/10.1007/s11136-017-1551-3

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