Skip to main content
SpringerLink
Log in

Economic Evaluation is Essential in Healthcare for the Elderly

A Viewpoint

  • Current Opinion
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The aging population is considered to be one of the major factors driving the cost of healthcare upward in industrialised countries. However, several analyses show that expenditure has increased mainly because of other factors. Expenditure is expected to increase when an aging population is combined with technical progress. In addition, the growing proportion of the population who are elderly means that there is an increasing proportion of people who do not work, creating further problems in the financing of healthcare. These problems make it imperative to provide medical care to the elderly in an efficient way.

Economic evaluation studies should render information about the cost-effectiveness of medical treatments as well as the preferences of patients. A MEDLINE-based review of the literature reveals that few studies specifically assess the cost-effectiveness of medical care for the elderly. Since age can influence the costs and effects of patient treatment, study results from younger patient samples may not adequately reflect the results to be expected for elderly patients. A significant information gap concerning the efficiency of care for the elderly thus exists, including information on the efficiency of drug treatment. There is also a need to test and, eventually, specify evaluation methodology (such as the appropriateness of quality of life measurement) for elderly patients.

Since the elderly have a shorter life expectancy, they may be at a disadvantage when cost-effectiveness measures are compared across age groups. Depending on the normative position, such comparisons can be accepted from a utilitarian, population-oriented perspective, or rejected from a libertarian, individualistic perspective. The normative position needs to be discussed when making use of evaluation results. Avoiding this discussion can bring about ethically unfavourable consequences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Organization for Economic Cooperation and Development (OECD). OECD-Health Data 97. OECD, Paris, 1997

    Google Scholar 

  2. Börsch-Supan A. Aging population. Econ Policy 1991 Apr; 103–39

    Google Scholar 

  3. Getzen TE. Population aging and the growth of health care expenditure. J Gerontol B Psychol Sci Soc Sci 1992; 47(3): S98–104

    CAS  Google Scholar 

  4. Gerdtham UG. The impact of aging on health care expenditure in Sweden. Health Policy 1993; 24(1): 1–8

    Article  PubMed  CAS  Google Scholar 

  5. Gray AM, Bosanquet N. Forecasting the impact of demographic change: the case of the British National Health Service. Health Policy 1992; 20(3): 269–75

    Article  PubMed  CAS  Google Scholar 

  6. Leidl R. Effects of population aging on health care, expenditure, and financing: some illustrations. In: Callahan D, ter Meulen RHJ, Topinkova E, editors. A world growing old: the coming health care challenges. Hastings Center Studies in Ethics. Washington, DC: Georgetown University Press, 1995: 49–61

    Google Scholar 

  7. Scitovsky AA. The high cost of dying revisited. Milbank Q 1994; 72(4): 561–91

    Article  PubMed  CAS  Google Scholar 

  8. Zweifel P, Felder S, Meier M. Demographic aging and health care cost: a misinterpretation [in German]. In: Oberender P, editor. Aging and health: health economic contributions. Vol. 26. Nomos: Baden-Baden, 1996: 29–46

    Google Scholar 

  9. Organization for Economic Cooperation and Development (OECD). Ageing in OECD countries: a critical policy challenge. Social policy studies No. 20. OECD, Paris, 1996

    Google Scholar 

  10. Verband der privaten Krankenversicherung e.V. The association of private health insurers 1996 [in German]. Köln, 1997

    Google Scholar 

  11. Drummond MF, O’Brien BJ, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997

    Google Scholar 

  12. Gold MR, Siegel JE, Russel RB, et al. Cost-effectiveness in health and medicine. Oxford: Oxford University Press, 1996

    Google Scholar 

  13. Bootman JL, Townsend RJ, McGhan WF, editors. Principles of pharmacoeconomics. Cincinnati: Harvey Whitney Company, 1996

    Google Scholar 

  14. Sloan FA, editor. Valuing health care: costs, benefits and effectiveness of Pharmaceuticals and other medical technologies. Cambridge: Cambridge University Press, 1995

    Google Scholar 

  15. Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995; 333(18): 1190–5

    Article  PubMed  CAS  Google Scholar 

  16. Cronewetter JL, Birkmeyer JD, Nackmann GB. Cost-effectiveness of carotid endarterectomy in asymptomatic patients. J Vasc Surg 1997; 25(2): 298–311

    Article  Google Scholar 

  17. Baltussen R, Leidl R, Ament A. The impact of age on cost-effectiveness ratios and its control in decision making. Health Econ 1996; 5: 227–39

    Article  PubMed  CAS  Google Scholar 

  18. Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst 1995; 87(6): 417–26

    Article  PubMed  CAS  Google Scholar 

  19. Baltussen R, Reinders A, Sprenger M, et al. Estimation excess hospitalization related to influenza: the case of the Netherlands. Epidemiol Infect 1998; 121(1): 129–38

    Article  PubMed  CAS  Google Scholar 

  20. Maiwenn JA, Bowine CM, Rutten FFH. The cost-effectiveness of diclofenac plus misoprostol compared with diclofenac monotherapy in patients with rheumatoid arthritis. PharmacoEconomics 1996; 10(2): 141–51

    Article  Google Scholar 

  21. Baladi JF, Menon D, Otten N. An economic evaluation of finasteride for treatment of benign prostatic hyperplasia. PharmacoEconomics 1996; 9(5): 443–54

    Article  PubMed  CAS  Google Scholar 

  22. Scott WG, Scott HM. Heart failure: a decision analytic analysis of New Zealand data using the published results of the SOLVD treatment trial. Pharmacoeconomics 1996; 9(2): 156–67

    Article  PubMed  CAS  Google Scholar 

  23. McHorney CA, Ware JE, Rachel LU, et al. The MOS 36-Item Short-Form Health Survey (SF-36): HI. tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994; 32(1): 40–66

    Article  PubMed  CAS  Google Scholar 

  24. Coast J, Peters TJ, Richards SH, et al. Use of the EuroQol among elderly acute care patients. Qual Life Res 1998; 7: 1–10

    Article  PubMed  CAS  Google Scholar 

  25. Brazier JE, Walters SJ, Nicholl JP, et al. Using the SF-36 and EuroQol on an elderly population. Qual Life Res 1996; 5: 195–204

    Article  PubMed  CAS  Google Scholar 

  26. Beusterin KM. Usefulness of the SF-36 health survey in measuring health outcomes in depressed elderly. J Geriatr Psychiatry Neurol 1996; 9(1): 13–21

    Google Scholar 

  27. McHorney CA. Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 Health Survey. Gerontologist 1996; 36(5): 571–83

    Article  PubMed  CAS  Google Scholar 

  28. Drummond M, Jönsson B, Rutten F. The role of economic evaluation in the pricing and reimbursement of drugs. Health Policy 1997; 40: 199–215

    Article  PubMed  CAS  Google Scholar 

  29. Oliver AT, Ikegami N, Ikeda S. Japan’s aging population: implications for healthcare. Pharmacoeconomics 1997; 11(4): 306–18

    Article  PubMed  CAS  Google Scholar 

  30. Maynard A. Evidence-based medicine: an incomplete method for informing treatment choices. Lancet 1997; 349: 126–8

    Article  PubMed  CAS  Google Scholar 

  31. Breyer F, Leidl R. What is evaluation good for in the health care system? In: Knappe E, editor. Reform strategy ‘managed care’: health economic contributions [in German]. Vol. 28. Baden-Baden: Nomos, 1997: 121–38

    Google Scholar 

  32. Callahan D. Setting limits: a response. Gerontologist 1994; 34(3): 393–8

    Article  PubMed  CAS  Google Scholar 

  33. Leidl R, Ament A, Baltussen R. Cost-effectiveness: analysis and age. In: Oberender P, editor. Aging and health: health economic contributions [in German]. Vol. 26. Baden-Baden: Nomos, 1996: 197–220

    Google Scholar 

  34. Dall J. Standards of medical care for older people in Europe. Eurohealth 1997; 3(2): 25–6

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Health Economics, University of Ulm, 89069, Ulm, Germany

    Reiner Leidl & Diana Stratmann

Authors
  1. Reiner Leidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Diana Stratmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reiner Leidl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leidl, R., Stratmann, D. Economic Evaluation is Essential in Healthcare for the Elderly. Drugs & Aging 13, 255–262 (1998). https://doi.org/10.2165/00002512-199813040-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199813040-00001

Keywords

Search

Navigation