The Cost of an Additional Disability-Free Life Year for Older Americans: 1992–2005
Article first published online: 7 JUN 2012
© Health Research and Educational Trust
Health Services Research
Volume 48, Issue 1, pages 218–235, February 2013
How to Cite
Cai, L. (2013), The Cost of an Additional Disability-Free Life Year for Older Americans: 1992–2005. Health Services Research, 48: 218–235. doi: 10.1111/j.1475-6773.2012.01432.x
- Issue published online: 7 JAN 2013
- Article first published online: 7 JUN 2012
- Value of spending;
- population aging;
- health care spending;
- multistate life table;
To estimate the cost of an additional disability-free life year for older Americans in 1992–2005.
This study used 1992–2005 Medicare Current Beneficiary Survey, a longitudinal survey of Medicare beneficiaries with a rotating panel design.
This analysis used multistate life table model to estimate probabilities of transition among a discrete set of health states (nondisabled, disabled, and dead) for two panels of older Americans in 1992 and 2002. Health spending incurred between annual health interviews was estimated by a generalized linear mixed model. Health status, including death, was simulated for each member of the panel using these transition probabilities; the associated health spending was cross-walked to the simulated health changes.
Disability-free life expectancy (DFLE) increased significantly more than life expectancy during the study period. Assuming that 50 percent of the gains in DFLE between 1992 and 2005 were attributable to increases in spending, the average discounted cost per additional disability-free life year was $71,000. There were small differences between gender and racial/ethnic groups.
The cost of an additional disability-free life year was substantially below previous estimates based on mortality trends alone.