Abstract
Crohn’s disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract affecting over 2 million people in Europe. The EQ-5D is the most commonly used instrument to obtain utility values for cost-effectiveness analyses of treatments for CD. We aimed to compare the measurement properties of the EQ-5D-3L and EQ-5D-5L in patients with CD. A multicentre cross-sectional survey was carried out in Hungary. Consecutive outpatients with CD completed the 3L, 5L and EQ VAS. The 3L and 5L were compared in terms of feasibility, ceiling effect, redistribution properties, discriminatory power, convergent and known-groups validity. 206 patients (mean age 35±11y, 45% female) participated in the study. For 3L, 25 unique health states were observed versus 59 for the 5L. The overall ceiling effect decreased from 29.6% (3L) to 25.5% (5L). Only 24 (2.3%) response pairs did not meet the criteria for consistency. Absolute discriminatory power (Shannon index) improved across all dimensions (3L 0.30 to 1.06 vs. 5L 0.37 to 1.65) indicating that the extra levels were effectively used. Relative discriminatory power (Shannon Evenness index) marginally increased for the dimension of pain/discomfort (3L 0.67 vs. 5L 0.71), while declined for the other four dimensions. The 3L and 5L index scores produced a strong (r=0.61, p<0.001) and a moderate-to-strong correlation (r=0.58, p<0.001) with EQ VAS, respectively. Both the 3L and 5L showed weak or very weak correlations with measures of disease severity. The 5L demonstrated a better known-groups validity on the basis of age and important clinical characteristics such as perianal fistulas and extraintestinal manifestations. The 5L seems to perform better than 3L in terms of feasibility, ceiling effect, absolute discriminatory power and known-groups validity. Further longitudinal studies are needed to compare the responsiveness and reliability of the two descriptive systems in this patient population.
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