Feng Yan, Herdman Mike, van Nooten Floortje, Cleeland Charles, Parkin David, Ikeda Shunya, Igarashi Ataru, Devlin Nancy J
Office of Health Economics, London, UK.
Formerly with Astellas Pharma BV, Leiden, The Netherlands.
Qual Life Res. 2017 Aug;26(8):2067-2078. doi: 10.1007/s11136-017-1541-5. Epub 2017 Mar 25.
To investigate the systematic differences in the self-reporting and valuation of overall health and, in particular, pain/discomfort between three countries (England/UK, Japan, and Spain) on the EQ-5D.
Existing datasets were used to explore differences in responses on the EQ-5D descriptive system between Japan (3L and 5L), the UK (3L), England (5L), and Spain (5L), particularly on the dimension of pain/discomfort. The role of different EQ dimensions in determining self-reported overall health scores for the EuroQol visual analog scale (EQ-VAS) was investigated using ordinary least squares regression. Time trade-off (TTO) results from Japanese and UK respondents for the EQ-5D-3L as well as Japanese and English respondents for the EQ-5D-5L were compared using t tests.
For the EQ-5D-3L, a higher percentage of respondents in Japan than in the UK reported 'no pain/discomfort' (81.6 vs 67.0%, respectively); for the EQ-5D-5L, the proportions were 79.2% in Spain, 73.2% in Japan, and 63-64% in England, after adjusting for age differences in samples. The 'pain/discomfort' dimension had the largest impact on respondents' self-reported EQ-VAS only for EQ-5D-3L in Japan. Using the EQ-5D-3L, Japanese respondents were considerably less willing to trade off time to avoid pain/discomfort than the UK respondents; for example, moving from health state, 11121 (some problems with pain/discomfort) to 11131 (extreme pain/discomfort) represented a decrement of 0.65 on the observed TTO value in the UK compared with 0.15 in Japan. Using the EQ-5D-5L, Japanese respondents were also less willing to trade off time to avoid pain/discomfort than respondents in England; however, the difference in values was much smaller than that observed using EQ-5D-3L data.
This study provides evidence of between-country differences in the self-reporting and valuation of health, including pain/discomfort, when using EQ-5D in general population samples. The results suggest a need for caution when comparing or aggregating EQ-5D self-reported data in multi-country studies.
研究三个国家（英国、日本和西班牙）在使用欧洲五维度健康量表（EQ-5D）时，自我报告的总体健康状况以及尤其是疼痛/不适方面的系统差异。
利用现有数据集，探讨日本（3L和5L）、英国（3L）、英格兰（5L）和西班牙（5L）在EQ-5D描述系统上的应答差异，特别是在疼痛/不适维度上的差异。使用普通最小二乘法回归研究不同EQ维度在确定欧洲五维度视觉模拟量表（EQ-VAS）的自我报告总体健康评分中的作用。使用t检验比较日本和英国受访者对EQ-5D-3L以及日本和英格兰受访者对EQ-5D-5L的时间权衡（TTO）结果。
对于EQ-5D-3L，日本报告“无疼痛/不适”的受访者百分比高于英国（分别为81.6%和67.0%）；对于EQ-5D-5L，在对样本年龄差异进行调整后，西班牙的比例为79.2%，日本为73.2%，英格兰为63 - 64%。仅在日本，对于EQ-5D-3L，“疼痛/不适”维度对受访者自我报告的EQ-VAS影响最大。使用EQ-5D-3L时，日本受访者比英国受访者更不愿意为避免疼痛/不适而权衡时间；例如，从健康状态11121（疼痛/不适有一些问题）转变为11131（极度疼痛/不适），在英国观察到的TTO值下降了0.65，而在日本为0.15。使用EQ-5D-5L时，日本受访者也比英格兰受访者更不愿意为避免疼痛/不适而权衡时间；然而，数值差异比使用EQ-5D-3L数据时观察到的要小得多。
本研究提供了证据，表明在一般人群样本中使用EQ-5D时，不同国家在健康状况（包括疼痛/不适）的自我报告和评估方面存在差异。结果表明，在多国研究中比较或汇总EQ-5D自我报告数据时需要谨慎。
