A review of the development and application of preference-based instruments with the older population

In Australia as in many developed countries, older people (aged 65 years and over) are the fastest growing age cohort and the proportion of individuals at the older end of the age spectrum (aged 75 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on aged care services. Government expenditure on aged care is costly and resource intensive, thus it is important to assess the cost effectiveness of interventions targeted for older people to identify interventions with the strongest capacity to enhance older peoples’ quality of life and provide value for money. Economic evaluation is a useful tool routinely applied in the health system to assist in resource allocation decision-making by comparing the costs and outcomes of different interventions. Despite its natural extension to aged care, to date there have been a dearth of economic evaluations conducted in the sector.

Cost-utility analysis is a form of economic evaluation that typically uses preference-based measures of quality of life to assess outcomes. This study provides a comprehensive review of the application of preference-based measures of quality of life with older people and highlights several important methodological and practical issues. Existing instruments do not routinely capture those dimensions of quality of life most important to older people including independence and control, social participation, safety and dignity. The study concludes by focusing on a new programme of research to develop an older person-specific preference-based measure for application in economic evaluation for the aged care sector.