The Use of EQ-5D in Research in the Middle East and North Africa Region: A Systematic Review

Introduction The EQ-5D questionnaire is one of the most commonly used measures of health-related quality of life worldwide. There is, however, only limited evidence on its use in the Middle East and North Africa (MENA) region. The objective of this literature review is to systematically identify and synthesize the published literature using the EQ-5D in this region.

Methods A systematic literature search was performed in PubMed, Cochrane, PsycINFO, and CINAHL. Studies published before December 2022 in English, Arabic, or French, using any version of EQ-5D in adults or youth in the MENA region were included. Pilot studies, guidelines, protocols, and reviews were excluded.

Extracted data were summarized in a systematic evidence table including information on clinical area, EQ-5D utility index values, reported EQ-5D results, study design, population, and value set used. Title/abstract/full text screening and data extraction was performed by two independent reviewers. Disagreements were resolved by a third reviewer.

Results Overall, 15,566 records were considered for title/abstract screening. After full text screening, 139 records covering 64,011 subjects fulfilled the inclusion criteria. Study countries included mainly Iran (54.40%), Saudi Arabia (25.19%), and Jordan (18.13%). There has been a notable increase of using the EQ-5D in the MENA region with 58% of the studies published after 2020 compared to 42% published between 2011 and 2019. 85% of the studies focused on patient populations, particularly targeting endocrine diseases (33%). An observational study design was adopted by 61% of all studies; only 8% used the EQ-5D for health-economic evaluations. The three- and five-level version of EQ-5D was used by 41% and 37% of studies, respectively. Only 20% of the studies reported visual analogue scores and frequencies of severity levels for each EQ-5D dimension separately. Funding sources and EQ-5D modes of administration were not reported in 22% and 20% of the records, respectively.

Conclusion The use of the EQ-5D questionnaire in the MENA region is increasing, particularly after 2020, and focuses predominantly on non-economic research. The reporting of main EQ-5D characteristics (indicating, e.g., mode of administration, version, value set) shows a high heterogeneity. Thus, clear guidance for standardized reporting of study results is needed.

Publication History

Article published online:
05 December 2024