How do we measure How healthy’ someone really is?
And how do we turn that into numbers that help shape health policy, pricing decisions and even drug approvals?
That’s where the EQ-5D-5L comes in. Created by the EuroQol Group, this simple yet powerful tool turns complex health experiences into quantifiable scores that underpin countless health technology assessments (HTAs), economic evaluations, and clinical trials around the world.
Let’s break it down, from how it works to why it matters, with real-world examples, visuals, and practical tips.
What Exactly Is the EQ-5D-5L?
At its core, the EQ-5D-5L is a standardised questionnaire that captures how people feel across five dimensions:
- Mobility
- Self-care
- Usual activities
- Pain/discomfort
- Anxiety/depression
Each of these has five levels, from “no problems” to “extreme problems,” resulting in 3,125 possible health states.
Add to that a Visual Analogue Scale (VAS), where you rate your health from 0 to 100, and you’ve got a remarkably compact yet comprehensive snapshot of someone’s quality of life.
You can complete the EQ-5D-5L on paper, digitally, face-to-face or even via proxy (if the patient isn’t able to self-report). NICE and most regulators prefer self-reported responses where possible.
The five answers produce a unique 5-digit health state, for example, 11234. That gets converted into a utility score using country-specific value sets. These scores usually fall between 0 (death) and 1 (perfect health), though negative scores can occur for health states considered worse than death.
Once you have a utility score, you can calculate a QALY — a quality-adjusted life year. It’s the backbone of health economics.
Live one year in perfect health (utility = 1) = 1 QALY.
Live one year at utility = 0.6 = 0.6 QALYs.
This helps answer questions like: Is this new drug worth funding? Does it improve life enough to justify the cost?
A Real-World Example:
In NICE’s evaluation of a new treatment for severe eczema, EQ-5D-5L was used to measure how patients’ lives changed. The results fed directly into the cost-effectiveness analysis that supported the drug’s approval.
Why Use EQ-5D-5L Over Other Tools?
| Tool | Dimensions | Pros | Cons |
| EQ-5D-5L | 5 | Simple, validated, widely accepted | Can miss subtle differences |
| SF-6D | 6 | Sensitive to mild issues | Not always accepted by HTA |
| HUI3 | 8 | Covers senses, emotion, cognition | More complex to complete |
| PROMIS | Varies | Customisable, digital-friendly | Less common in economic work |
EQ-5D-5L results lend themselves well to charts:
- Radar plots show changes across dimensions pre- and post-treatment.
- Utility distributions highlight inequalities in population health.
- EQ VAS scores can track overall perceived wellbeing over time.
(If you are building reports or models, these visuals help tell the story clearly.)
No tool is perfect. Here are some limitations you should know:
- Ceiling effect: Many people score ‘11111’ even with underlying conditions.
- Cultural differences: What counts as a “problem” in one country might not in another.
- Missing data: Imputation is often needed, especially in longitudinal studies.
- Mapping quirks: NICE still wants EQ-5D-5L scores mapped to the older 3L value set, which can dilute sensitivity.
Over 30 countries have their own EQ-5D-5L value sets — including the UK, France, Spain, Germany, Japan, and Canada. You can check the full list at euroqol.org.
That means your results can be tailored to national preferences, which is crucial in global trials or multi-country HTA submissions.
TL;DR — Why the EQ-5D-5L Still Matters
✔ It’s simple, scalable, and globally accepted
✔ It links health experiences to economic value (via QALYs)
✔ It’s embedded in NICE, EMA and global HTA pathways
✔ It tells a compelling story when paired with good visualisation
Whether you’re a researcher designing a study, a policymaker weighing up funding decisions or a medtech innovator seeking reimbursement — the EQ-5D-5L is a tool you’ll want in your kit.