Economic evaluation is essential in healthcare for the elderly. A viewpoint.

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.