EQ-5D-5L population norms for Singapore: a household survey-based analysis.

Abstract

Population norms for the EQ-5D-5L are essential for health economic evaluations. However, existing norms for Singapore were established before the COVID-19 pandemic, whose prolonged health and societal impacts may have rendered them outdated. Updated post-pandemic benchmarks are therefore needed to inform cost-utility analyses and public health policy accurately. This study aimed to establish updated EQ-5D-5L population norms among Singapore residents aged ≥ 15 years and to examine variation in health-related quality of life (HRQoL) by sociodemographic characteristics. We conducted a cross-sectional household survey between May and July 2024 among Singapore citizens and permanent residents, using a three-stage sampling strategy with demographic quotas. We assessed HRQoL using the EQ-5D-5L and EQ VAS. We derived index scores using the Singapore-specific value set. We generated descriptive statistics and used multivariable linear regression to identify independent associations between HRQoL and sociodemographic characteristics. The analysis included 2,005 respondents. While 54.6% reported no problems ('11111'), pain/discomfort (30.7%) and anxiety/depression (27.1%) were the most prevalent issues. The mean EQ-5D-5L index score was 0.933 (SD 0.122), and the mean EQ VAS score was 82.3 (SD 13.3). Multivariable regression showed that older age was most strongly associated with lower HRQoL (p < 0.001). Higher socioeconomic status, measured by income and housing type, was independently associated with better HRQoL. Gender was not significantly associated with either outcome. This study provides updated, post-pandemic EQ-5D-5L population norms for Singapore. These norms offer an essential benchmark for interpreting EQ-5D-5L scores in cost-utility analyses and highlight priorities for addressing socioeconomic health inequalities.