Table 3 The solutions of indicated problems suggested in the studies

Lower QALY caused by lower LE

Introducing “end-of-life” rule (higher valuation of gained years in the case of terminal illnesses with no more than 2 years to live) [25].

When the EOL rule is implemented, age discrimination can only emerge under very rare conditions [25].

Introducing discounting: gains of life years are diminished when they occur in the distant future [18].

Discounting greatly reduces the problem, and may make it almost negligible [18].

Equal value of QALY regardless of age

To adjust the results of QALY analysis to better match general public opinion by introducing age-correction (age weighting of QALY) [28, 30,31,32,33, 35, 37].

The problem is too complex to be solved by age-weights [31].

Research mainly focused on life-saving interventions may wrongly interpret social preferences [31].

Future research should be conducted before introducing such a solution, also combining age with other factors like gender or socio-economic status [30, 33].

More equitable distribution will cause lower efficiency [37].

Such weights may become arbitrary and give the possibility of abuse [37].

Lower gains in QoL possible for older people

Determining different thresholds of QALY accepted for financing for different age groups [40].

Not a sufficient solution

if all dimensions important for older people’s QoL are not taken into account at the same time [40].

Calibration of health state valuation to best attainable health prospect [41].

No motivation for seeking methods to improve a health state level which is deemed “normal” [41].

QoL measure instrument inadequacy

Developing a proper age-specific preference-based indicator for QoL measurement [40, 46].

Health-related QoL measured regardless of age; no beyond-health QoL aspects taken into account

Using EQ-5D in combination with another instrument suitable for older people (e.g. ICECAP-O or ASCOT) [45].

There is no single existing measure that could assess QoL in a sense broad enough for older people [45].

Further research is needed to identify relevant attributes of health-related QoL for different age groups [38].

Developing a new, age-specific measure of QoL, targeted at older people, based more on capability than functioning and preference-based utility [40, 46].

To allocate budget separately for different levels of care and beneficiaries’ age, using appropriate assessment criteria [26].