Purpose: To perform a systematic review of the literature on the utility weights for colorectal cancer (CRC) health states; to determine the effects of study characteristics and role of “time to/from initial care” on utility values.
Method: In a systematic review we identified 22 articles in English, providing 171 unique utilities for CRC health states elicited from 3574 respondents. Some utilities were estimated from SF-36 scores. Data were analyzed using Linear Mixed-Effects with CRC cancer type, condition, stage, time to/from initial care, instrument, administration and study design as independent variables.
Result: In the base model, the estimated utility of the reference case (scenario of a stage I/II CRC patient in continuous care, more than 1 year post-operation, rated by using EQ5D/HUI3) was 0.75. Cancer type, condition, stages, time to/from initial care, instruments and study design were associated with utility differences of 0.06 to 0.13 (P < 0.05). Utilities derived by using the EQ5D/HUI3 instruments were 0.07 lower than EQ5Dvas and 0.12 lower than SF-36 (P < 0.05) in the base model. Utilities for I/II stage were 0.13 (P < 0.05) higher than stage VI and 0.13 (P = 0.05) lower than Dukes stages. Utilities elicited at “post-operation more than 1 year” were 0.08 (P < 0.05) less than “preoperative” and 0.06 (P < 0.05) lower than “post-operation 3 months” in the base model.
Conclusion: The review of utility values for CRC shows few quality of life studies for surveillance and terminal care health states. This has the potential to introduce uncertainty in the cost-effectiveness analysis results. Utilities are associated with factors such as cancer type, time to/from initial care and utility derivation instruments. More research is needed to study why “similar” patients appear to have different quality of life.
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