Overview, Update, and Lessons Learned From the International EQ-5D-5L Valuation Work: Version 2 of the EQ-5D-5L Valuation Protocol

A standardized 5-level EuroQol 5-dimensional questionnaire (EQ-5D-5L) valuation protocol was first used in national studies in the period 2012 to 2013. A set of problems encountered in this initial wave of valuation studies led to the subsequent refinement of the valuation protocol. To clarify lessons learned and how the protocol was updated when moving from version 1.0 to the current version 2.1 and 2.0, this article will (1) present the challenges faced in EQ-5D-5L valuation since 2012 and how these were resolved and (2) describe in depth a set of new challenges that have become central in currently ongoing research on how EQ-5D-5L health states should be valued and modeled. •In 5-level EuroQol 5-dimensional questionnaire valuation studies, we have obtained important new insights concerning how respondent behavior and features of the task work together to define the level of precision of composite time trade-off responses.•This motivated the introduction of a quality control process and of new modeling approaches.•The rigorous approach to 5-level EuroQol 5-dimensional questionnaire valuation studies inspires trust in the validity of value sets.