Psychometric properties of EQ-5D-Y-3L versus EQ-5D-Y-5L Arabic versions in healthy and diseased children

There is growing interest in using Health-Related Quality of Life (HRQOL) instruments in clinical practice for children and adolescents. Before widespread use, it is important to critically evaluate the psychometric properties of new or updated HRQOL tools in different health conditions. This study aimed to evaluate psychometric properties of the Arabic versions of EQ-5D-Y-3L and EQ-5D-Y-5L among children and adolescents with different health conditions in Egypt. Healthy children and adolescents from schools and those with cancer or diabetes from hospitals, aged 8–15, were self-completed EQ-5D-Y-3L and EQ-5D-Y-5L in randomized order. Feasibility, discriminatory power, ceiling effect, convergent validity, redistribution properties, and test–retest reliability were compared to evaluating performance. A total of 273 participants completed the surveys for the first time at recruitment. There were 0% missing responses on both versions. Time to complete EQ-5D-Y-3L and EQ-5D-Y-5L was almost the same, with medians of 2.5 and 2.67 min, respectively. About 55.7% of participants preferred EQ-5D-Y-5L over EQ-5D-Y-3L, and 81.7% believed it best represented their health. The average improvement in absolute informativity of EQ-5D-Y-5L dimensions was 0.397. Ceiling effect was reduced by 19.4%. There were moderate to strong significant correlations across dimensions of both versions with EQ VAS. Inconsistent responses ranged from 1.5% to 5.9%. To assess reliability, 188 participants completed the surveys for the second time and weighted Kappa results showed moderate to substantial agreement. The EQ VAS, EQ-5D-Y-3L, and EQ-5D-Y-5L level sum scores demonstrated good reliability. Both Arabic versions are valid, feasible, reliable, and recommended for use among healthy and ill children/adolescents across age range (8–15 years). EQ-5D-Y-5L allows better health expression, improves absolute informativity, and reduces ceiling effects compared to EQ-5D-Y-3L, while maintaining comparable validity and reliability.