A head-to-head comparison of health utilities and measurement properties of the EQ-5D-5L and SF-6Dv2 among people living with HIV in China.

PURPOSE: To compare health utilities and measurement properties of the EQ-5D-5L and SF-6Dv2 among people living with HIV (PLHIV) in China, and to identify factors associated with utility values. METHODS: A multicenter cross-sectional survey was conducted among PLHIV in Shandong, Guangdong, and Sichuan provinces. Utilities were calculated using Chinese value sets. Ceiling/floor effects were evaluated. Convergent validity and agreement were assessed using Spearman's rank correlation, intraclass correlation coefficients (ICC), and Bland-Altman (B-A) plots. Known-groups validity and discriminative performance were evaluated using effect sizes and relative efficiency. Tobit models identified factors associated with utilities. RESULTS: Among 705 respondents, mean (SD) utilities were 0.93 (0.15) for EQ-5D-5L and 0.80 (0.17) for SF-6Dv2. Ceiling effects were higher for EQ-5D-5L than SF-6Dv2 (48.2 vs. 14.3%). The instruments showed good convergent validity (r = 0.719) and agreement (ICC = 0.729), but the B-A limits of agreement spanned 0.48, exceeding the instrument-defined minimally important difference (MID) of 0.06. Both instruments discriminated across known groups. The EQ-5D-5L had higher relative efficiency for comorbid chronic disease, CD4 + T-cell counts, and prior HIV self-testing experience, whereas the SF-6Dv2 had higher relative efficiency for duration of ART, economic burden, and self-rated health. Comorbid chronic disease, no prior HIV self-testing experience, and heavy economic burden were associated with lower utility values. CONCLUSIONS: Both instruments showed acceptable measurement properties among Chinese PLHIV, but systematic utility differences suggest they should not be used interchangeably. These findings support objective-driven instrument selection and may inform cost-utility analyses and utility-improvement targets.