The Ceiling Effects of EQ-5D-3L and 5L in General Population Health Surveys: A Systematic Review and Meta-analysis

ObjectivesThis review aims to examine the ceiling effects of EQ-5D-3L (3L) and EQ-5D-5L (5L) in general adult populations and identify the factors influencing these effects.MethodsWe searched eight databases for observational studies published in English from inception to 24 July 2023. Ceiling effects were calculated by dividing the number of participants reporting full health at dimension or profile level by the total sample size. Subgroup analysis and meta-regression using the metafor package in R software were performed.ResultsWe identified 94 studies from 70 articles, including 4,543,647 adults across 37 countries. The global pooled proportion of individuals reporting full health (‘11111’) was 56% (95% CI 51-62%) for 3L and 49% (95% CI 44-54%) for 5L. The self-care dimension showed the highest ceiling effects (3L: 97%; 5L: 94%), while pain/discomfort had the lowest (3L: 69%; 5L: 60%). The ceiling effects in East/South-East Asia were higher than in Europe by 25% (95% CI 18-32%) in 3L and 9% (95% CI -2-20%) in 5L. Adjusting for mean age and proportion of males, significant regional differences persisted in the overall profile level of 3L, in all 3L dimensions (except for self-care), and in all 5L dimensions (except for pain/discomfort and anxiety/depression).ConclusionThis review highlights significant ceiling effects in the EQ-5D, especially in Asian populations. The 5L version exhibited fewer ceiling effects than the 3L, indicating its superiority for general population surveys. Further research is crucial to understand the disparities in self-reported health outcomes between Asians and other populations.