Public Health

EuroQol 5-Dimension 5-Level (EQ-5D-5L): A Full Guide for Researchers and Clinicians

Introduction

The EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire, developed by Michael Herdman, Claire Gudex, Andrew Lloyd, Mark Oppe, Paul Kind, Xavier Badia, and Nan Luo, is a cornerstone in health-related quality of life (HRQoL) assessment, widely adopted since its development in 2009 by the EuroQol Research Foundation. With over 6,000 citations on Google Scholar, it’s a go-to tool for researchers and clinicians evaluating health outcomes across diverse populations (Herdman et al., 2011; Feng et al., 2021).

Designed to capture health status in five key dimensions—mobility, self-care, usual activities, pain/discomfort, and anxiety/depression—it’s both simple and robust, making it ideal for clinical practice, economic evaluations, and population health studies. In this article, we’ll break down its features, applications, and why it’s a must-have in your research or clinical toolkit, with insights tailored for experts like you.

Key Features of the EuroQol 5-Dimension

Purpose and Use

The EQ-5D-5L measures HRQoL to support clinical decision-making, cost-utility analyses (e.g., calculating Quality-Adjusted Life Years), and population health surveillance. Its versatility makes it a staple in multinational studies across over 75 countries.

Target Population

Validated for adults aged 18 and older, the EQ-5D-5L is suitable for young adults, middle-aged adults, older adults, and seniors. It’s not designed for children or adolescents, but youth versions (EQ-5D-Y-3L, EQ-5D-Y-5L) exist for younger populations.

Structure

The tool includes five questions, each targeting a specific dimension, plus a Visual Analogue Scale (VAS) for self-rated health. Each dimension uses a 5-level Likert scale (1 = no problems, 5 = extreme problems), ensuring nuanced data collection. The VAS ranges from 0 (worst imaginable health) to 100 (best imaginable health).

The response types involve a Likert scale (1-5 for dimensions), multiple-choice (selecting the level), and a rating scale (0-100 for VAS).

Scoring Method

The EQ-5D-5L offers two primary scoring methods:

Level Sum Score (LSS): Sum the scores from each dimension (1–5), yielding a total of 5–25. Higher scores indicate worse health status.
Utility Score: Derived from country-specific value sets, these scores reflect societal preferences for health states, often used in economic evaluations.
VAS Score: A 0–100 scale where patients rate their overall health.

Because the LSS is straightforward, it’s great for quick clinical assessments, while utility scores shine in cost-effectiveness studies. However, interpretation depends on context—country-specific value sets are critical for accurate utility scoring.

Administration Format

The EuroQol 5-Dimension 5-Level (EQ-5D-5L) offers flexibility in administration and can be completed via:

Paper-based forms
Digital (Online) platforms
Interviews (In-person)
Mobile app
Phone and Video Calls

No special training is necessary to administer or interpret the EQ-5D-5L, as it is self-administered. Administration is typically quick, estimated at less than 5 minutes.

Applications of the EuroQol 5-Dimension

The EQ-5D-5L’s simplicity and adaptability make it invaluable across settings:

Screening: Identifies patients with significant HRQoL impairments.
Monitoring: Tracks health status changes over time, especially post-intervention.
Research: Supports clinical trials and health economic studies, particularly for cost-utility analyses.
For example, researchers use it to evaluate treatment outcomes in oncology, while clinicians apply it to tailor rehabilitation plans.

Languages and Availability

To support global use, the EQ-5D-5L is available in over 170 languages, including Arabic, English, Mandarin Chinese, Spanish, French, Russian, German, Portuguese, Japanese, and Hindi, ensuring accessibility in diverse cultural contexts.

The EQ-5D-5L is free for non-commercial use but requires permission for commercial purposes.

Reliability and Validity

The EQ-5D-5L is recognized as a highly reliable and valid instrument for assessing HRQoL. For instance, Mokken scaling has demonstrated strong scalability (Hs = 0.714, excluding the anxiety/depression dimension), indicating good psychometric properties. Numerous validation studies across various languages and patient populations have further solidified its credibility, with over 6,000 citations for key references or studies where the questionnaire was used or validated.

Several studies underscore the EQ-5D-5L’s robustness:

- Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) (link)
- Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study (link).
- Validation of the EQ-5D-5L and psychosocial bolt-ons in a large cohort of people living with multiple sclerosis in Australia (link).
- Validity of EQ-5D-5L health-related quality of life questionnaire in self-reported diabetes: evidence from a general population survey (link).

These studies, among others, highlight why the EQ-5D-5L is a gold standard in HRQoL research.

Limitations and Considerations

However, despite its strengths, the EQ-5D-5L has a few limitations:

Self-report: Respondents may be influenced by social desirability bias or personal interpretation.
Social Desirability Bias: Participants may respond in a way they believe is socially acceptable rather than accurate.
Requires Value Sets for Utility Scoring: The scoring process depends on the availability of validated value sets, which may not be universally accessible.

Additional Resources

For more information on the EQ-5D-5L and to access the full questionnaire, visit the following resources:

Questionnaire PDF: Access via EuroQol website.
User Guide: Consult the EQ-5D-5L User Guide.
Inquiries: Contact the EuroQol Research Foundation at info@euroqol.org.
Further Reading: (link), (link).

Frequently Asked Questions (FAQ)

Who can use the EQ-5D-5L?
Researchers, clinicians, and health economists use it for adults aged 18+ across various health conditions.
How long does it take to complete the EQ-5D-5L?
It takes less than 5 minutes, making it highly practical for clinical and research settings.
How is the EQ-5D-5L administered?
It’s available in paper-based, digital, mobile app, and interview formats, offering maximum flexibility.
Is there any cost to using the EQ-5D-5L?
It’s free for non-commercial use; commercial use requires permission from the EuroQol Research Foundation.
What are the related questionnaires?
Alternatives include EQ-5D-3L, EQ-5D-Y-3L, EQ-5D-Y-5L, SF-36, HUI, AQoL, 15D, and QWB.

A word from ResRef about EuroQol 5-Dimension

The EQ-5D-5L is a gold-standard tool for HRQoL assessment, validated across diverse populations and settings. Its simplicity and adaptability make it indispensable for clinical and economic research. Whether you’re designing a clinical trial or optimizing patient care, integrating the EQ-5D-5L into your workflow provides actionable insights that drive better outcomes.

References

Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011 Dec;20(10):1727-36. doi: 10.1007/s11136-011-9903-x. Epub 2011 Apr 9. PMID: 21479777; PMCID: PMC3220807 (link).
Janssen MF, Pickard AS, Golicki D, Gudex C, Niewada M, Scalone L, Swinburn P, Busschbach J. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res. 2013 Sep;22(7):1717-27. doi: 10.1007/s11136-012-0322-4. Epub 2012 Nov 25. PMID: 23184421; PMCID: PMC3764313 (link).
Campbell JA, Ahmad H, Chen G, van der Mei I, Taylor BV, Claflin S, Henson GJ, Simpson-Yap S, Laslett LL, Hawkes K, Hurst C, Waugh H, Palmer AJ. Validation of the EQ-5D-5L and psychosocial bolt-ons in a large cohort of people living with multiple sclerosis in Australia. Qual Life Res. 2023 Feb;32(2):553-568. doi: 10.1007/s11136-022-03214-y. Epub 2022 Aug 29. PMID: 36036311; PMCID: PMC9911481 (link).
Jankowska A, Młyńczak K, Golicki D. Validity of EQ-5D-5L health-related quality of life questionnaire in self-reported diabetes: evidence from a general population survey. Health Qual Life Outcomes. 2021 May 5;19(1):138. doi: 10.1186/s12955-021-01780-2. PMID: 33952271; PMCID: PMC8097836 (link)
Feng YS, Kohlmann T, Janssen MF, Buchholz I. Psychometric properties of the EQ-5D-5L: a systematic review of the literature. Qual Life Res. 2021 Mar;30(3):647-673. doi: 10.1007/s11136-020-02688-y. Epub 2020 Dec 7. PMID: 33284428; PMCID: PMC7952346 (link).
Al Sayah, F., Alam, A., Short, H. et al. Norms for the EQ-5D-5L among the general adult population in Alberta, Canada. Qual Life Res 34, 219–230 (2025). Doi:10.1007/s11136-024-03804-y. (link)