A Review and Meta-analysis of Colorectal Cancer Utilities Sandjar Djalalov, PhD, Linda Rabeneck, MD, MPH, George Tomlinson, PhD, Karen E. Bremner, BSc, Robert Hilsden, MD, PhD, Jeffrey S. Hoch, PhD Objective. To perform a systematic review of utility weights for colorectal cancer (CRC) health states reported in the scientific literature and to determine the effects of disease factors, patient characteristics, and utility meth- ods on utility values. Methods. We identified 26 articles written in English and published from January 1980 to January 2013, providing 351 unique utilities for CRC health states elicited from 6546 unique respondents. The CRC utility data were analyzed using linear mixed-effects models with CRC type, stage, time to or from initial care, utility measurement instrument, and administration method as independent variables. Results. In the base case model, the estimated utility for a patient with stage I to III CRC more than 1 year after surgery, rated using a self-administered time tradeoff instrument, was 0.90. Stage, time to or from initial care, and utility measurement instrument were associated with statistically significant utility differences ranging from –0.19 to 0.02. Utilities for patients with stage IV cancer were 0.19 lower (P \ 0.001) than for those with stage I to III cancer. Utilities elicited at more than 1 year after surgery were 0.05 higher than those elicited at 3 months after surgery (P = 0.008). Esti- mates of differences between utility measurement instru- ments were sensitive to how repeated scores in the same patient group were treated, and other findings were sensi- tive to how the disease stage was modeled and method of administration. Conclusions. Variations in reported utili- ties are associated with factors such as cancer stage, time to or from initial care, and utility measurement instrument. More research is needed to study why appar- ently similar patients report different quality of life. Key words: colorectal cancer; quality of life; preferences; util- ity assessment; meta-analysis. (Med Decis Making 2014;34:809–818) C olorectal cancer (CRC) is one of the most com- mon malignancies in the world and is the sec- ond leading cause of cancer death in Western countries, with incidence rates increasing for both females and males. 1 CRCs start in the cells that line the inside of the colon or the rectum, and these cells take several years to grow and transform into cancer. If left untreated, the cancer cells can grow into the muscle layers underneath and through the bowel wall. If it is detected early, CRC is readily cured by surgical resection. However, if it is detected late and the tumor has already spread to other organs, few patients survive longer than 5 years. 2 Received 1 March 2012 from the Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada (SD, JSH); Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, ON, Canada (LR, GT, JSH); Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH); Toronto General Hospital, Toronto, ON, Canada (KEB); Univer- sity of Calgary, Calgary, AB, Canada (RH); Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, ON, Canada (GT); and Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada (SD, JSH). This research was sup- ported by Canadian Institutes of Health Research (CIHR) grant CST-85478 (‘‘CIHR Team in Population-Based Colorectal Cancer Screening’’) and funding from ARCC. The Pharmacoeconomics Research Unit is supported by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care. This research does not reflect the views of the funders. ARCC is funded by a grant from the Canadian Cancer Research Institute. Revision accepted for publication 29 April 2014. Ó The Author(s) 2014 Reprints and permission: http://www.sagepub.com/journalsPermissions.nav DOI: 10.1177/0272989X14536779 Supplementary material for this article is available on the Medical Decision Making Web site at http://mdm.sagepub.com/supplemental. Address correspondence to Jeffrey S. Hoch, PhD, Pharmacoeconom- ics Research Unit, Cancer Care Ontario, 620 University Avenue, Tor- onto, ON M5G 2L7, Canada; e-mail: jeffrey.hoch@utoronto.ca. MEDICAL DECISION MAKING/AUGUST 2014 809 REVIEW