The cost of an additional disability-free life year for older Americans: 1992-2005.
OBJECTIVE
To estimate the cost of an additional disability-free life year for older Americans in 1992-2005.


METHODS
This study used 1992-2005 Medicare Current Beneficiary Survey, a longitudinal survey of Medicare beneficiaries with a rotating panel design.


METHODS
This analysis used multistate life table model to estimate probabilities of transition among a discrete set of health states (nondisabled, disabled, and dead) for two panels of older Americans in 1992 and 2002. Health spending incurred between annual health interviews was estimated by a generalized linear mixed model. Health status, including death, was simulated for each member of the panel using these transition probabilities; the associated health spending was cross-walked to the simulated health changes.


RESULTS
Disability-free life expectancy (DFLE) increased significantly more than life expectancy during the study period. Assuming that 50 percent of the gains in DFLE between 1992 and 2005 were attributable to increases in spending, the average discounted cost per additional disability-free life year was $71,000. There were small differences between gender and racial/ethnic groups.


CONCLUSIONS
The cost of an additional disability-free life year was substantially below previous estimates based on mortality trends alone.
National Health Statistics Group, Office of the Actuary, Centers for Medicare & Medicaid Services, Baltimore, MD 21244-1850, USA. liming.cai@cms.hhs.gov
Liming
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Cai
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011788:Quality of Life; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States