Comparing apples and oranges: does cost-effectiveness analysis deal fairly with the old and young?

This paper considers the role patient age plays in the type of outcome analysis most germane for policymakers: cost-effectiveness analysis. The magnitude of age bias is quantified and means to modify it are described. In particular, present value analysis (discounting) is demonstrated to markedly attenuate the effect of patient age on cost-effectiveness analysis. As the discount rate gets larger, the difference in potential "life-years" between old and young gets smaller and the age bias is minimized. However, relegating a decision about the importance of patient age to a decision about the discount rate seems inappropriate. Value judgments cannot be avoided; therefore, it is best that they be explicit.