Project Title: Utility Values Following Surgery for Colorectal Cancer: a systematic review and meta-analysis
Background: Health-state utility values (HSUVs) quantify preference-weighted health-related quality of life and are required for cost-utility analyses. Evidence following colorectal cancer surgery is fragmented across procedures, instruments and follow-up periods. We aimed to synthesise HSUVs following surgical treatment of colorectal cancer and generate pooled estimates for economic modelling.
Methods: MEDLINE, Embase, Scopus, Web of Science Core Collection, CINAHL and ProQuest were searched. English-language empirical studies reporting directly elicited or preference-based utility values in patients undergoing colorectal cancer surgery were included. Study characteristics, elicitation methods, surgical health states and assessment timing were narratively synthesised. Comparable EQ-5D estimates were pooled using random-effects meta-analysis by instrument and postoperative timepoint.
Results: Thirty-five studies were included: 14 rectal cancer, four colon cancer and 17 mixed colorectal cancer studies. Considerable heterogeneity was observed in surgical interventions, utility instruments and assessment timing. Across the narrative synthesis, the most consistent pattern was an early postoperative reduction in utility followed by recovery within three to six months and relatively stable long-term utilities. Local excision and organ-preserving rectal procedures generally demonstrated stable or improving utilities, while more extensive rectal surgery showed greater early postoperative reductions. Fifteen studies contributed to meta-analysis. Pooled EQ-5D-3L utility was 0.82 (95% CI 0.76–0.88) pretreatment and decreased to 0.78 (0.75–0.81) at one month, before increasing to 0.85 (0.75–0.95) during intermediate recovery and 0.83 (0.81–0.86) at six months. Corresponding EQ-5D-5L estimates were 0.84 (0.69–0.99) pretreatment and 0.70 (0.64–0.76) at one month.
Conclusions: Utility typically declines during early postoperative recovery and improves by three to six months, with relatively stable long-term survivorship values. These estimates provide inputs for cost-utility models, while heterogeneity supports matching utilities to instrument, surgical context, disease state and time since surgery.