A direct comparison of the measurement properties of the PROMIS-16 and EQ-5D-5L in the U.S. general population

Abstract

Objectives Introduced in 2024, the PROMIS®-16 is a health-related quality of life (HRQoL) instrument that measures eight dimensions: physical function, ability to participate in social roles and activities, anxiety, depression, sleep disturbance, pain interference, cognitive function, and fatigue. Given the potential overlap in dimensions, this study compares the measurement and psychometric properties of the PROMIS-16 and EQ-5D-5L. Methods In 2024, an online cross-sectional survey was conducted with a nationally representative sample of U.S. adults aged 18 years or older (N = 2577), including the EQ-5D-5L and PROMIS-16 as stand-alone instruments. We compared the measurement properties of the PROMIS-16 and the EQ-5D-5L, namely ceiling and floor percentages, informativity (Shannon’s indices), and convergent/divergent validity. Furthermore, we conducted an exploratory factor analysis to identify their combined structure. Results Within construct-overlapping items, the PROMIS-16 items exhibited greater dispersion, including lower ceiling percentages and higher informativity, compared to their EQ-5D-5L counterparts. Good convergent validity between PROMIS-16 and EQ-5D-5L items was observed for physical functioning (mobility; r = 0.85) and anxiety/depression (r = 0.760.79). EFA captured six distinct constructs: Physical Function, Social Roles & Activities, Anxiety / Depression, Pain Interference, Cognitive Function, and Sleep / Fatigue. Possibly due to reverse coding, the two Cognitive Function items of PROMIS-16 showed inconsistent performance, with weak correlations and limited alignment with other constructs. Conclusions The PROMIS-16 items demonstrated greater conceptual coverage and informativity than the EQ-5D-5L, but issues with inconsistent framing and potential response biases remained. On the other hand, the EQ-5D-5L demonstrated stronger concordance with respondents’ global health assessments compared to the PROMIS-16.