Do QALYs discriminate against the elderly? An empirical analysis of published cost effectiveness analyses

Objectives Critics of quality-adjusted life years (QALYs) argue that it discriminates against older individuals. However, little empirical evidence has been produced to inform this debate. To compare published cost effectiveness analyses (CEAs) on patients aged ≥65 years and those aged <65 years. Methods We used the Tufts Cost-Effectiveness Analysis Registry to identify CEAs published in Medline between 1976 and 2021. Eligible CEAs were categorized according to age (≥65 years versus <65 years). The distributions of incremental cost effectiveness ratios (ICERs) were compared between the age groups. We used logistic regression to assess the association between age groups and the cost-effectiveness conclusion adjusted for confounding factors. We conducted sensitivity analyses to explore the impact of mixed age and age-unknown groups and all ICERs from the same CEAs. Subgroup analyses were also conducted. Results 4,445 CEAs categorized according to age <65 years (n = 3,784) and age ≥65 years (n = 661) were included in the primary analysis. The distributions of ICERs and the likelihood of concluding that the intervention was cost-effective were similar between the two age groups. Adjusted odds ratios (ORs) ranged from 1.132 (95% CI, 0.930, 1.377) to 1.248 (95%CI, 0.970, 1.606)(OR >1 indicating that CEAs for aged ≥65 years were more likely to conclude the intervention was cost effective than those for age < 65 years). Sensitivity and subgroup analyses found similar results. Conclusion Our analysis found no systematic differences in published ICERs using QALYs between CEAs for individuals age ≥65 years and those for individuals age< 65 years.