Comparison of the measurement properties of the EQ-5D-3L, ICECAP-O and ASCOT in frail older adults

BACKGROUND The ICEPOP CAPability measure for Older people (ICECAP-O) and Adult Social Care Outcomes Toolkit (ASCOT) are preference-based measures for assessing quality of life (QoL) from a broader perspective than do traditional health-related QoL measures such as the EuroQol five-dimensional questionnaire (EQ-5D). Measurement properties of these instruments have not yet been directly compared. OBJECTIVE The purpose of this study was to compare the test-retest reliability, construct validity and responsiveness of the three-level EQ-5D (EQ-5D-3L), ICECAP-O and ASCOT in frail older adults living at home. METHODS Cross-sectional data and longitudinal data were used. Parameters for reliability (the intraclass correlation coefficient) and agreement (standard error of measurement) were used to assess test-retest reliability after 1 week. We formulated hypotheses about correlations with other measures and tested these to assess construct validity and responsiveness (longitudinal validity). RESULTS The reliability parameters for all three scales were considered good (intraclass correlation coefficient values above 0.70). Standard error of measurement values were less than 10% of the scale. Hypotheses regarding construct validity were in general accepted; the EQ-5D-3L was more strongly associated with physical limitations than were the ICECAP-O and ASCOT and less strongly with instruments measuring aspects beyond health. Longitudinally, as hypothesized, mental health was most strongly associated with the ICECAP-O, and self-perceived QoL, mastery and client-centeredness of home care most strongly with the ASCOT. CONCLUSIONS Our findings support the adoption of the ICECAP-O and ASCOT as outcome measures in economic evaluations of care interventions for older adults that have a broader aim than health-related QoL, because they are at least as reliable as the EQ-5D-3L and are associated with aspects of QoL broader than health.