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. 2025 Dec 5.
doi: 10.1007/s10198-025-01867-3. Online ahead of print.

A cross-country comparison of the psychometric performance of SF-6Dv2 and EQ-5D-5L

Hosein Ameri  1   2 , Brendan Mulhern  3 , Richard Norman  4 , Takeru Shiroiwa  5 , Rajabali Daroudi  6 , Thomas G Poder  7   8
Affiliations

A cross-country comparison of the psychometric performance of SF-6Dv2 and EQ-5D-5L

Hosein Ameri et al. Eur J Health Econ. .

Abstract

Objective: To evaluate the comparative performance of SF-6Dv2 and EQ-5D-5L in the general population of Quebec (Canada), Tehran (Iran), and Japan.

Methods: Data on SF-6Dv2 and EQ-5D-5L were collected in the three countries. Descriptive differences in utility values between SF-6Dv2 and EQ-5D-5L were assessed using t-tests, as well as ceiling effects were evaluated based on the percentage of "no problem" levels reported. The known-group validity of both measures was assessed by comparing utility scores across health and demographic subgroups using t-tests or ANOVA and by calculating effect sizes across known groups. The area under the receiver operating characteristic curve (AUROC) analysis and F-statistic ratios were used to further validate the findings from the known-group validity analyses. Convergent validity for both instruments was assessed using Spearman's rank correlation coefficient. The agreement between instruments was evaluated using intraclass correlation coefficients (ICC) and Bland-Altman plots.

Results: A total of 2,378 respondents for Quebec, 3,061 for Tehran, and 3,933 for Japan were included. Differences in utility values between SF-6Dv2 and EQ-5D-5L were statistically significant, with SF-6Dv2 generally yielding lower utility scores. Both instruments demonstrated strong known-group validity, effectively distinguishing between diseased and healthy groups as well as various demographic characteristics. However, EQ-5D-5L outperformed SF-6Dv2 for most demographic characteristics based on AUROC analysis and F-statistic ratios. In contrast, their performance in distinguishing between healthy and diseased groups did not favor a particular instrument. Convergent validity analyses indicated strong associations between SF-6Dv2 and EQ-5D-5L utility values in Quebec (0.760) and Tehran (0.737). The agreement between SF-6Dv2 and EQ-5D-5L utility values was moderate in Quebec (0.69) and strong in Tehran (0.837). Bland-Altman plots indicated that differences between the two instruments tended to increase as the average score decreased.

Conclusion: Both EQ-5D-5L and SF-6Dv2 demonstrated favorable psychometric performance in terms of known-group validity and convergent validity. These findings suggest that both instruments are valid tools for health utility measurement for use in general population.

Keywords: EQ-5D-5L; Health-related quality of life; Psychometric properties; SF-6Dv2.

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Conflict of interest statement

Declarations. Ethical approval: Each study was approved by its respective research ethics committee: the Quebec study by the Comité d’éthique de la recherche of the CIUSSS de l’Estrie–CHUS (approval #2016 − 1350) and the Comité d’éthique de la recherche en sciences et en santé de l’Université de Montréal (approval #2023 − 445); the Iran study by the National Research Committee (approval no. IR.TUMS.REC.1394.743); and the Japan study by the Ethics Committee of the National Institute of Public Health (approval no. NIPHIBRA #12338). Informed consent: Informed consent was obtained from all patients in each of the three studies. Conflict of interest: the authors declare that they have no conflict of interest.

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