OBJECTIVES: Despite being used to inform drug reimbursement and coverage decisions in several countries, the use of quality-adjusted life years (QALYs) is controversial. Critics of QALYs argue that it discriminates against older individuals. However, little empirical evidence has been produced to inform this debate. Our objective was to compare results from published cost-effectiveness analyses (CEAs) for patients aged ≥65 years and <65 years.

METHODS: We used the Tufts Cost-Effectiveness Analysis Registry to identify CEAs published in Medline through 2021. CEAs were categorized according to age group (≥65 versus <65 years). The distributions of incremental cost-effectiveness ratios (ICERs) were compared between groups. We used logistic regression to assess the association between age group and the cost-effectiveness conclusion adjusted for confounding factors including the use of lifetime horizon, perspective, and disease. We conducted sensitivity analyses to explore the impact of mixed-age, age-unknown groups, and ICERs from the same CEA. Subgroup analyses by key characteristics were also conducted.

RESULTS: We identified 4,445 CEAs, that we categorized according to age <65 years (n=3,784) and ≥65 years (n=661). More CEAs for patients ≥65 years used a lifetime horizon and societal perspective. The distributions of ICERs and the likelihood of concluding that the intervention was cost-effective were similar between groups. Adjusted odds ratios (ORs) ranged from 1.132 (95%CI, 0.930-1.377) to 1.248 (95%CI, 0.970-1.606), with an OR>1 indicating that CEAs for aged >65 years were more likely to conclude the intervention was cost-effective. Sensitivity and subgroup analyses found similar results.

CONCLUSIONS: Our analysis found no differences in published ICERs between CEAs for patients age ≥65 years compared to <65 years. This analysis was limited to cross-sectional data. Within-study comparison may provide further evidence showing whether the use of QALYs has systematically discriminated against older people.