ABSTRACT
The intrinsic value of elderly disease prevention (EDP) lies in promoting elderly health and well-being. But the broad socioeconomic challenges of population ageing make instrumental values increasingly important: facilitating paid and unpaid work and active leisure, reducing health sector and fiscal burdens associated with population ageing, and reducing care and support burdens on households. Instrumental values are especially associated with interventions that reduce morbidity or increase functional ability. Elderly individuals will not choose socially optimal levels of investment in prevention because of externalities; the significant informational and cognitive burdens of rational choice in this area; problems associated with self-control, biases, and heuristics; and equity. Thus, socially optimal investments in EDP require a strong government role. Among likely high value-for-money investments are those addressing basic needs; taxes and regulations, especially regarding cigarettes, alcohol, and food; universal healthcare; vaccination; and various preventive clinical services. Standard economic evaluations of EDP interventions adopt a health payer perspective and cost-utility analysis. These focus only on interventions’ health gains and payer budget implications, ignoring the socioeconomic consequences of improved health and risking underinvestment. Remedying such risk requires greater use of the societal perspective and cost-benefit analysis in economic evaluation. Better valuation methods can facilitate socially optimal investments in EDP and send better market signals for research and development into future generations of preventive technologies. Difficult policy questions remain regarding how to balance dynamic efficiency on the one hand and static efficiency and equity on the other.
