Population norms for the EQ-5D-3L in China derived from the 2013 National Health Services Survey

Abstract

Background: EQ-5D-3L is one of the most commonly used instruments for assessing health-related quality of life and cost-utility analyses, but it is not yet available in China. This study aims to develop population norms for the EQ-5D-3L in China in order to encourage appropriate use and interpretation of the EQ-5D-3L instrument.

Methods: Data were extracted from the 2013 National Health Services Survey on a nationally representative sample of 188 720 participants. The utility index based on the 2018 Chinese preference-based value sets were calculated for the participants with different demographic and socio-economic characteristics. Differences in reported problems and visual analogue scale (VAS) and utility index scores were tested using a logistic, linear and tobit regression model, respectively.

Results: The Chinese respondents were less likely to report problems on the EQ-5D dimensions compared with most populations in other countries. Pain/discomfort was the most commonly reported problem (12.6%). This resulted in a high ceiling effect (84.19%) on the utility index and high mean scores for the utility index (0.985 ± 0.056) and VAS (80.91 ± 13.74) in the Chinese population. Those who were younger, better educated, employed, married, had no illness condition, lived in a more developed region and had a higher income obtained higher scores in both VAS and utility index. The VAS and utility index scores were also associated with gender, residency and lifestyles, but not always in a consistent way. Male and rural residents had a higher VAS score but not in the utility index compared with their female and urban counterparts.

Conclusions: This study provides national population norms for the EQ-5D-3L based on the 2018 Chinese preference-based value sets. The norms can be used as a reference for health evaluation studies. Cautions need to be taken for presenting and interpreting the utility index results given the high ceiling effect of the EQ-5D-3L instrument.