Response-scale heterogeneity in the EQ-5D

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This paper discusses two types of response-scale heterogeneity, which may impact upon the EQ-5D. Response-scale heterogeneity in reporting occurs when individuals systematically differ in their use of response scales when responding to self-assessments. This type of heterogeneity is widely observed in relation to other self-assessed measures but is often overlooked with regard to the EQ-5D. Analogous to this, preference elicitation involving the EQ-5D could be subject to a similar type of heterogeneity, where variations across respondents may occur in the interpretations of the levels (response categories) being valued. This response-scale heterogeneity in preference elicitation may differ from variations in preferences for health states, which have been observed in the literature. This paper explores what these forms of response-scale heterogeneity may mean for the EQ-5D and the potential implications for researchers who rely on the instrument as a measure of health and quality of life. We identify situations where they are likely to be problematic and present potential avenues for overcoming these issues.
Original languageEnglish
Pages (from-to)387-394
Number of pages8
JournalHealth Economics
Issue number3
Publication statusPublished - Mar 2017


  • anchoring vignettes
  • differential item functioning
  • EQ-5D
  • multi-attribute utility instruments
  • preference heterogeneity
  • reporting heterogeneity
  • response-scale heterogeneity

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