Health-related quality of life in patients with cervical cancer: a systematic review and meta-analysis of EQ‑5D utility scores

Cervical cancer substantially impairs HRQoL, particularly among women in socially and economically productive age groups. EQ-5D utility values are important inputs for quality-adjusted life-year estimation, cost–utility analysis, and health technology assessment; however, pooled EQ-5D estimates for cervical cancer remain limited. This PRISMA 2020-compliant systematic review and meta-analysis searched PubMed, Embase, Scopus, and the Cochrane Library from inception to July 2025. The protocol was registered in PROSPERO (CRD420251077051). Eligible studies included adults with cervical cancer reporting EQ-5D-3 L, EQ-5D-5 L, EQ-5D VAS, or EQ-5D domain-level outcomes. Random-effects meta-analysis was used to estimate pooled mean utility and VAS scores. Heterogeneity, publication bias, sensitivity analyses, subgroup analyses, prediction intervals, and meta-regression were assessed. Twenty-four studies including 281,958 participants from 15 countries were included. Seventeen studies contributed to the EQ-5D utility meta-analysis, yielding a pooled mean utility score of 0.79 (95% CI: 0.73–0.85; 95% prediction interval: 0.52–1.05; I² = 99.6%). Seventeen studies reported EQ-5D VAS scores, with a pooled mean of 71.82 (95% CI: 67.95–75.69; 95% prediction interval: 54.54–89.11; I² = 98.3%). Stage-specific estimates were inconsistent, particularly for Stage IV disease, and should be interpreted cautiously because of small sample size, potential survivor bias, and high between-study variability. Pain/discomfort and anxiety/depression were the most frequently affected EQ-5D domains. Cervical cancer is associated with reduced HRQoL. The pooled EQ-5D estimates provide useful reference values for economic evaluations and HTA, but substantial heterogeneity and wide prediction intervals indicate that local adaptation and cautious interpretation are required.