The aging population is considered to be one of the major factors driv
ing 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 po
pulation is combined with technical progress. In addition, the growing
proportion of the population who are elderly means that there is an i
ncreasing proportion of people who do not work, creating further probl
ems in the financing of healthcare. These problems make it imperative
to provide medical care to the elderly in an efficient way. Economic e
valuation studies should render information about the cost-effectivene
ss of medical treatments as well as the preferences of patients. A MED
LINE-based review of the literature reveals that few studies specifica
lly assess the cost-effectiveness of medical care for the elderly. Sin
ce age can influence the costs and effects of patient treatment, study
results from younger patient samples may not adequately reflect the r
esults to be expected for elderly patients. A significant information
gap concerning the efficiency of care for the elderly thus exists, inc
luding information on the efficiency of drug treatment. There is also
a need to test and, eventually, specify evaluation methodology (such a
s the appropriateness of quality of life measurement) for elderly pati
ents. Since the elderly have a shorter life expectancy, they may be at
a disadvantage when cost-effectiveness measures are compared across a
ge groups. Depending on the normative position, such comparisons can b
e accepted from a utilitarian, population-oriented perspective, or rej
ected from a libertarian, individualistic perspective. The normative p
osition needs to be discussed when making use of evaluation results. A
voiding this discussion can bring about ethically unfavourable consequ
ences.