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The impact of age on health utility values for older women with early-stage breast cancer: a systematic review and meta-regression

Wang, Yubo; Gavan, Sean P.; Steinke, Douglas; Cheung, Kwok Leung; Chen, Li Chia


Yubo Wang

Sean P. Gavan

Douglas Steinke

Li Chia Chen


Introduction: An increasing number of postmenopausal women are diagnosed with breast cancer at an older age (≥ 70years). There is a lack of synthesised health utility data to support decision-making for managing breast cancer in this older population. This study aimed to identify the availability of, and the subsequent impact of age on, health state utility values (HSUVs) measured by the EQ-5D for older women with early-stage breast cancer. Method: This systematic review identified EQ-5D (3L or 5L version) HSUVs for postmenopausal women with early-stage breast cancer. Studies were identified from a previous systematic review (inception to 2009) and an electronic database search (Medline and Embase; 2009 to September 2021). Mean HSUVs were summarised by health state. Quality appraisal was performed on studies reporting HSUVs for older ages (≥ 70 years). Multivariable meta-regression assessed the association between HSUVs and age, health state, treatments received, and time of measuring the utility values (greater or less than one year post-treatment). Results: Fifty EQ-5D HSUVs were identified from 13 studies. Mean HSUVs decreased as health state worsened: from the stable (mean=0.83) to progression (mean=0.79) and advanced (mean=0.68) states. Two studies reported six HSUVs estimated from the sample of women with a mean age ≥ 70. Meta-regression model fit improved by including age as an independent variable and attenuated the estimated utility decrements associated with worse health states. Utility decrements for the progression and advanced states were -0.052 (95%CI: -0.097, -0.007) and -0.143 (95%CI: -0.264, -0.022) respectively. The breast cancer-specific utility decrement associated with a one-year increase in age was -0.001 (95%CI: -0.004, 0.002). Conclusion: Relevant and accurate HSUVs are essential to help support decision-making about the most effective and cost-effective ways to manage early-stage breast cancer in older women. Age has a vital role in determining health utility values in this population. This study provides analysts and decision-makers with HSUVs and utility decrements that reflect the disease process in this older population.


Wang, Y., Gavan, S. P., Steinke, D., Cheung, K. L., & Chen, L. C. (2022). The impact of age on health utility values for older women with early-stage breast cancer: a systematic review and meta-regression. Health and Quality of Life Outcomes, 20(1), Article 169.

Journal Article Type Review
Acceptance Date Nov 7, 2022
Online Publication Date Dec 23, 2022
Publication Date Dec 23, 2022
Deposit Date Jan 11, 2023
Publicly Available Date Jan 11, 2023
Journal Health and Quality of Life Outcomes
Electronic ISSN 1477-7525
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 20
Issue 1
Article Number 169
Keywords Public Health, Environmental and Occupational Health; General Medicine
Public URL
Publisher URL


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