Instrument template · Health utilityUpdated September 28, 2026

EQ-5D eCRF template for utilities and QALYs

Five questions and a visual analogue scale that health technology assessment bodies rely on. Capture the EQ-5D-5L with coded levels and an EQ VAS with no preset value, so index values and QALYs can be calculated cleanly.

  • 5 dimensions × 5 levels
  • EQ VAS 0 to 100, no preset value
  • Licence on the form

Free sandbox · No credit card · 21 CFR Part 11 aligned

Your health today

EQ-5D-5L · Month 3

Mobility

Level 1 no problems · 5 unable / extreme

12345

Pain / discomfort

12345

Health today (EQ VAS)

0 worst imaginable100 best imaginable
Health state 21311 · VAS 72

EQ-5D at a glance

  • The EQ-5D-5L has five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression, each with five levels from no problems to extreme problems or unable.
  • The answers form a five-digit health state (for example 21311). There are 3,125 possible states.
  • The EQ VAS asks participants to rate their overall health today from 0 (worst imaginable) to 100 (best imaginable).
  • Health states convert to an index value using a country-specific value set, anchored at 1 (full health) and 0 (dead), which feeds QALY calculations for health economics.
  • The EQ-5D is licensed by the EuroQol Research Foundation. Register your study; commercial use involves a fee, and electronic versions follow EuroQol's requirements.

The instrument

Why payers care about a five-question survey

Health technology assessment bodies compare treatments by cost per quality-adjusted life year. To calculate QALYs they need a utility value for each participant's health at each time point, on a scale where 1 is full health and 0 is equivalent to death. The EQ-5D is the most widely used way to get those values from trial participants, and several agencies state a preference for it.

That makes it common in Phase 3 trials planning a reimbursement submission, and increasingly in earlier studies that want to model value early. It is also a useful generic quality of life measure in its own right, short enough to add to almost any visit.

5L or 3L?

The older EQ-5D-3L has three levels per dimension (243 states). The 5L version added two levels to reduce ceiling effects and improve sensitivity. Most new trials use the 5L; check which your target HTA bodies expect and whether a value set exists for your countries. A youth version (EQ-5D-Y) is available for children and adolescents.

The EQ VAS

The VAS captures the participant's own overall rating of health today. On a phone, it becomes a slider from 0 to 100 with the anchors shown. Capture's visual analogue scales have no preset value, so the participant has to move the marker themselves rather than accepting a default. EuroQol specifies how the EQ VAS must be presented in electronic versions; confirm your layout with them when you register.

EQ-5D-5L · Health state and utility

Health state

21311

EQ VAS

72

Value set

Country

Mobility: slight problems2/5
Self-care: no problems1/5
Usual activities: moderate problems3/5
Pain / discomfort: no pain1/5
Anxiety / depression: none1/5
Index value applied in analysis

Structure

EQ-5D-5L dimensions and levels

DimensionLevelseCRF field
Mobility1 no problems to 5 unableSingle choice or linear scale, coded 1 to 5
Self-care1 no problems to 5 unableCoded 1 to 5
Usual activities1 no problems to 5 unableCoded 1 to 5
Pain / discomfort1 none to 5 extremeCoded 1 to 5
Anxiety / depression1 not to 5 extremelyCoded 1 to 5
EQ VAS0 to 100Slider with anchors, no preset value
Health stateFive digitsDerived in analysis from the five codes
Index valueCountry value setDerived in analysis

Structure only. Register with the EuroQol Research Foundation for the questionnaire, official translations and value sets.

Licensing

EuroQol registration, recorded on the form

Record the EuroQol licence number, holder and expiry on the EQ-5D form. The form shows a staff-only watermark until the licence is recorded, and new data collection is blocked if the licence lapses.

eCOA software with licence tracking
PROMIS SF v1.0 · Fatigue 8a · Settings

Copyright & licence

Approval pending
Licence required

Licence number

Not recorded

Expiry date

Not recorded

Watermark shown to staff only. Participants never see it.

Health economics

Schedule it where the model needs it

Economic models need utilities at baseline, at regular intervals and at key clinical events. Place the EQ-5D at those visits once; the same form runs at every site on participants' phones or clinic tablets, and exports carry the codes your health economists need.

Schedule of assessments · Phase 3 with HTA plans
AssessmentBLM3M6M9M12EoTFU
EQ-5D-5L
Disease-specific QoL
Resource use

Try the EQ VAS slider on your phone

Build the EQ-5D form in the free sandbox and complete it as a participant.

Build your EQ-5D form free

Analysis

Getting EQ-5D data your health economists can use

Economists will convert every health state into a utility, then into QALYs across the trial and often beyond it in a model. That chain is only as good as the timing and completeness of the data collected. Three decisions made at protocol stage matter most.

Timing around events

Utility changes around clinical events such as hospitalisation, progression or surgery. If the EQ-5D is only collected at fixed visits, those dips may be missed. Consider additional collection at event-driven visits, and at the end of treatment and follow-up, so the model has data where health actually changes.

Value sets by country

Index values depend on the value set used. Multi-country trials usually analyse with one reference value set for the main analysis and national sets for country-specific submissions. Record country on the demographics form or derive it from site, so the right value set can be applied.

Ceiling effects and missing data

Many relatively healthy participants report 11111, so the EQ-5D can be insensitive in mild conditions; the 5L version reduces this compared with the 3L. Missing questionnaires are common in later follow-up, and the pattern often relates to health status, so define how missing data will be handled in the analysis plan and use reminders to keep completion high.

Before go-live

EQ-5D setup checklist

Registered with EuroQol

Version (5L, 3L or Y), languages and electronic format confirmed; licence recorded on the form.

VAS layout approved

Electronic EQ VAS presentation follows EuroQol's requirements.

Value sets chosen

Reference and national value sets named in the analysis plan.

Event-driven collection

Extra administrations around key clinical events if the model needs them.

Country recorded

Available for value set selection.

Completion monitored

Reminders and dashboard review so later time points are not lost.

FAQ

Questions about this template

Something not covered here? Ask us directly.

What is the EQ-5D-5L?

A generic health status questionnaire with five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), each rated on five levels, plus the EQ VAS.

How is the EQ-5D scored?

The five answers form a health state code, which a country-specific value set converts into an index value anchored at 1 for full health and 0 for dead. The EQ VAS is reported directly, 0 to 100.

What is the EQ VAS?

A visual analogue scale on which participants rate their overall health today from 0 (worst imaginable) to 100 (best imaginable).

Is the EQ-5D free?

It requires registration with the EuroQol Research Foundation. Commercial use involves a fee; some non-commercial uses are free.

Does Capture calculate EQ-5D index values?

Capture stores the five codes and the VAS value; index values are applied in analysis using the value set for each country.

Can participants complete it on their phone?

Yes. The VAS becomes a slider with no preset value. Follow EuroQol's requirements for electronic versions.

Collect utility data your economists can use

Coded levels, an honest VAS and the licence on record. Free sandbox.

Build your EQ-5D form free