ECONOMIC-EVALUATION IS ESSENTIAL IN HEALTH-CARE FOR THE ELDERLY - A VIEWPOINT

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.