Comparison of the HUI3 and the EQ-5D-3L in a nursing home setting

BACKGROUND Accurately assessing changes in the quality of life of older people living permanently in nursing homes is important. The multi-attribute utility instrument most commonly used and recommended to assess health-related quality of life in the nursing home population is the three-level EuroQol EQ-5D-3L. To date, there have been no studies using the Health Utilities Index Mark III (HUI3). The purpose of this study was to compare the level of agreement and sensitivity to change of the EQ-5D-3L and HUI3 in a nursing home population. METHODS EQ-5D-3L and HUI3 scores were measured as part of a cluster randomised controlled trial of nurse led care coordination in a nursing home population in Perth, Western Australia at baseline and 6-month follow up. RESULTS Both measures were completed for 199 residents at baseline and 177 at 6-month follow-up. Mean baseline utility scores for EQ-5D-3L (0.45; 95% CI 0.41-0.49) and HUI3 (0.15; 95% CI 0.10-0.20) were significantly different (Wilcoxon signed rank test, p<0.01) and agreement was poor to moderate between absolute scores from each instrument (intra-class correlation coefficient = 0.63). The EQ-5D-3L appeared more sensitive to change over the 6-month period. CONCLUSION Our findings show that the EQ-5D-3L and HUI3 estimate different utility scores among nursing home residents. These differences should be taken into account, particularly when considering the implications of the cost-effectiveness of particular interventions and we conclude that the HUI3 is no better suited to measuring health-related quality of life in a nursing home population when compared to the EQ-5D-3L.