OBJECTIVES: The NICE reference case specifies EQ-5D as the preferred health-related quality of life (HRQoL) measure. However, there is debate around whether EQ-5D is appropriate for all conditions. This review aims to summarise the evidence on the appropriateness of EQ-5D across conditions. It examines EQ-5D’s use in NICE appraisals in areas where evidence suggests it may not be the most appropriate measure.

METHODS: Systematic reviews and NICE Decision Support Unit (DSU) documents on EQ-5D appropriateness were identified through targeted literature search and reviewed to inform the ongoing NICE methods review. We examined appropriateness of EQ-5D by reviewing the evidence on its validity, responsiveness, and reliability. We compiled a list of conditions where the evidence suggested that EQ-5D may not be appropriate and reviewed NICE technology appraisals in these conditions. We extracted and summarised NICE appraisal committees’ conclusions relating to EQ-5D appropriateness.

RESULTS: Reviewed evidence suggests that EQ-5D has good validity, responsiveness, and reliability in most conditions. However, it lacked responsiveness in hearing-related conditions. There was mixed evidence in multiple sclerosis, mental health conditions, visual disorders, and HIV. None of the published reviews covered any rarer diseases. Alternative measures proposed included other generic HRQoL measures for example HUI3, disease-specific preference-based measures and bolt-ons to EQ-5D. In the absence of evidence for EQ-5D inappropriateness, NICE appraisal committees preferred EQ-5D where both EQ-5D and alternatives were presented. One committee accepted HUI3 for hearing impairment in absence of EQ-5D data.

CONCLUSIONS: NICE’s reference case specifies EQ-5D but allows the case to be made for an alternative HRQoL measure if evidence demonstrates EQ-5D is inappropriate. The evidence did not identify an overwhelming need to change these methods. However, EQ-5D’s limited performance in some conditions, such as hearing-related conditions, shows the importance of allowing flexibility where there is suitable evidence of inappropriateness.