Estimating the relationship between EQ-5D-5L and EQ-5D-3L

Project theme: Methods development

It has been shown that the EQ5D-3L and EQ5D-5L are likely to give very different values to changes in health. Therefore, 3L and 5L cannot be used interchangeably if consistency in decision making is required. This raises several important challenges, one of which is the need to be able to translate reliably from one instrument to the other.

Whilst there are current estimates linking 3L and 5L responses and values (see notes 1 and 2 below), these estimates are limited by the underlying data which come from two sources. They are vastly underpowered, do not span relevant populations and it is unknown whether the degree of separation between 3L and 5L questions is sufficient.

There is a need for a reference case mapping approach, given the likely need to link 3L and 5L for decades to come. This need was also recognised by NICE in their interim position statement on the use of 5L.



The aim of the project is to develop a reference case mapping between 3L and 5L, suitable for mapping in either direction.

Project team 

Monica Hernández Alava, Stephen Pudney, Allan Wailoo and Georgios Chrysanthou.


Monica Hernández Alava


Hernández Alava, M., Pudney, S. and Wailoo, A. (2020) Estimating the relationship between EQ-5D-5L and EQ-5D-3L: results from an English population study (PDF, 1.3MB). Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York. Report 063. DOI: 

Stata, Excel and R commands implementing the results of the reference case mapping between 3L and 5L can be downloaded from the DSU website.


Hernández Alava, M., Pudney, S. & Wailoo, A. (2022) Estimating the Relationship Between EQ-5D-5L and EQ-5D-3L: Results from a UK Population Study. PharmacoEconomics.

Hernández-Alava, M., & Pudney, S. (2022). Mapping between EQ-5D-3L and EQ-5D-5L: A survey experiment on the validity of multi-instrument data. Health Economics, 1– 17.

Wailoo, A., Hernández Alava, M., Pudney, S., Barton, G., O’Dwyer, J., Gomes, M., Irvine, L., Meads, D. and Sadique, Z. (2021) An international comparison of EQ-5D-5L and EQ-5D-3L for use in cost-effectiveness analysis, Value in Health, ISSN 1098-3015. doi: