Healthcare Cost-Effectiveness Analysis for Older Patients. Using Cataract Surgery and Breast Cancer Treatment Data

The percentage of elderly, over the age of 65, in the U.S. population will be changing dramatically over the next 20-30 years. The changing demographics over the next three decades will have significant consequences for Medicare and national policy. Given the economic impact of future health care expenditures by our growing elderly population, a concerted effort needs to be made to define high quality yet cost-effective medical therapy for older patients. The purpose of this dissertation is to explore the use of both clinical trials and evidence based decision models in performing cost-effectiveness analysis in elderly patients. For some diseases, such as cataract surgery, the majority of patients tend to be older. Therefore, previous studies focusing on younger patients do not exist. Important therapeutic and policy questions can only be addressed through a clinical trial. Other diseases, such as breast cancer, involve a wider age range of patients from early 40s to 90s. For such diseases, there is a literature of clinical trials on younger patients and the young elderly, 60 -70. This previous literature can be used to develop decision analysis models to help define pertinent questions and areas for further research (i.e., clinical trials).