Abstract

Objectives

This systematic review compared the distributional characteristics and measurement properties of EuroQol’s EQ-5D-Y-3L and EQ-5D-Y-5L instruments, using results from published head-to-head comparative studies.

Methods

The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-COnsensus-based Standards for the selection of health Measurement INstruments (PRISMA-COSMIN) guideline. We searched 8 databases up to February 14, 2024 for studies on the measurement properties and distributional characteristics (missing data, ceiling/floor effects, consistency, and informativity) of both EQ-5D-Y versions. Measurement quality was assessed in terms of the proportion of tests meeting COSMIN recommended criteria for reliability, validity, and responsiveness.

Results

Eighteen studies were included. The Y-5L reduced ceiling effects by 0.8% to 16.5% and had a slightly higher evenness index, indicating greater informativity. Both versions showed sufficient construct validity across patient and general population samples, with the Y-5L slightly outperforming the Y-3L in known-group validity. Both the Y-3L and Y-5L versions showed sufficient test-retest reliability for mobility, pain/discomfort, and worried, sad, or unhappy and inconsistent reliability for looking after myself and usual activities, indicating similar performance across these dimensions. The Y-5L showed better responsiveness (standardized effect size range = 0.03-2.05) than Y-3L (range = 0.13-0.94). In proxy-reported data, the Y-5L appears to have slightly lower test-retest reliability than the Y-3L, despite demonstrating better agreement with self-reported data.

Conclusions

Both EQ-5D-Y versions demonstrated varying psychometric performances across the evaluated populations, with the Y-5L slightly outperforming the Y-3L in responsiveness and proxy-child agreement. The availability of the Y-5L expands the options of health-related quality-of-life instruments for assessing pediatric populations. Further research is needed to assess its performance across diverse populations and administrative modes.