The Gerontologist, Vol 31, Issue 3 332-336, Copyright © 1991 by The Gerontological Society of America
Comparing apples and oranges: does cost-effectiveness analysis deal fairly with the old and young?
Dartmouth Medical School, Hanover, NH.
This paper considers the role patient age plays in the type of outcome
analysis most germane for policymakers: cost-effectiveness analysis. The
magnitude of age bias is quantified and means to modify it are described.
In particular, present value analysis (discounting) is demonstrated to
markedly attenuate the effect of patient age on cost- effectiveness
analysis. As the discount rate gets larger, the difference in potential
"life-years" between old and young gets smaller and the age bias is
minimized. However, relegating a decision about the importance of patient
age to a decision about the discount rate seems inappropriate. Value
judgments cannot be avoided; therefore, it is best that they be explicit.