Quality of Life Research

, Volume 24, Issue 7, pp 1759–1765 | Cite as

Do health preferences contradict ordering of EQ-5D labels?

  • Benjamin M. Craig
  • A. Simon Pickard
  • Kim Rand-Hendriksen



The aim of this study was to test whether the ordering of item labels in EQ-5D instruments disagrees with the preferences of US adults.


A preference inversion occurs when “worse” health along a scale or score is preferred. As a sub-study of the 2013 United States Measurement and Valuation of Health Study, we tested for 33 EQ-5D preference inversions using paired comparisons with unique samples of 50 or more US adults, aged 18 or older. Specifically, we tested whether health preferences contradicted ordering of EQ-5D labels.


The EQ-5D-3L and EQ-5D-Y item labels had no significant preference inversions. The EQ-5D-5L version had preference inversions between Levels 4 and 5. For example, 30 out of 59 respondents (51 %) preferred being “extremely” over “severely anxious or depressed,” contrary to the ordering of labels for that item.


Preference inversions between Levels 4 and 5 on the EQ-5D-5L were tested and confirmed; therefore, valuation studies may find that Levels 4 and 5 have the same value. To mitigate such inversions, labels could be revised or a 4-level version could be considered.


EQ-5D QALY Health preferences Psychometrics Item response Scales 



The authors thank Michelle Owens, Shannon Runge, and Carol Templeton at Moffitt Cancer Center for their contributions to the research and creation of this paper. Financial support for this study was provided by a grant from the National Institutes of Health, Department of Health and Human Services, through the National Cancer Institute (1R01CA160104), the EuroQol Group (EQ Project 2013100) and Dr. Craig’s support account at Moffitt Cancer Center. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

Conflict of interest

There are no conflicts of interest.


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Benjamin M. Craig
    • 1
  • A. Simon Pickard
    • 2
  • Kim Rand-Hendriksen
    • 3
  1. 1.Health Outcomes and Behavior, Moffitt Cancer CenterUniversity of South FloridaTampaUSA
  2. 2.Department of Pharmacy Systems, Outcomes and Policy, College of PharmacyUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Department of Health Management and Health EconomicsUniversity of OsloOsloNorway

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