The importance of age in allocating health care resources: does intervention-type matter?
BACKGROUND
Recent proposals to reform cost-effectiveness analysis (CEA) by weighting health benefits [(Quality-adjusted life-years) QALYs] by recipients' age are based on studies examining age-related preferences in life-saving contexts. We investigated whether the perceived importance of age in resource allocation decisions differs among intervention-types.


METHODS
160 individuals were recruited from a cafeteria of a university medical centre and asked to choose between hypothetical health care programmes. Scenario A described two programmes treating life-threatening conditions and Scenario B two programmes providing palliative care. Programmes were identical except in average patient age (35 versus 65). Respondents also directly rated the importance of age for allocating resources for six types of interventions.


RESULTS
Responses for the life-saving scenario favoured younger age groups while those for the palliative care scenario showed no age preference. The difference between scenarios was statistically significant. When directly rating the importance of age in allocating treatment resources, people placed greatest importance on age in treating infertility and life-saving, and least importance in treating depression.


CONCLUSIONS
The importance people place on age as a resource allocation criterion depends on the clinical context. As QALYs serve as a common measure of health benefits for all intervention types, age weighting of QALYs is premature.
Johri
Mira
M
SOLIDAGE -- McGill University, Université de Montréal Research Group on Integrated Services for Older Persons, Canada. mira.johri@umontreal.ca
Damschroder
Laura J
LJ
Zikmund-Fisher
Brian J
BJ
Ubel
Peter A
PA
D000328:Adult; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D005260:Female; D015276:Health Care Rationing / Q000191:economics*; D019538:Health Care Surveys / Q000191:economics; D006292:Health Priorities / Q000191:economics*; D006296:Health Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years