The Value of Healthcare in the United States: Changes in Lifetime Spending and Health-Adjusted Life Expectancy, 1996 to 2016

Abstract

Objectives

We build on research of Cutler et al on the value of healthcare spending using a period life-expectancy framework. We use the framework to track health-adjusted life expectancy (HALE) and lifetime spending for all ages, show the value of improvements in healthcare, and demonstrate the contribution of expanding research to the full age range.

Methods

We used population-level results on mortality and years lived with disability from the 2019 Global Burden of Disease, Injuries, and Risk Factor Study and spending from the 2016 Disease Expenditure study. We used cause replacement methods to simulate effects of changes in healthcare. For 132 causes, we replaced cause-specific outcomes (or spending) per case from 1996 with those measures for 2016; effect is the difference between base year and simulated calculations. Spending is reported in 2016 US dollars ($).

Results

For all-cause aggregate calculated at birth, lifetime spending effect was $234 111 (95% uncertainty interval (UI): 221 395, 242 456) and HALE effect was 1.285 (95% UI: 1.161, 1.422) years per person. Value of improvements is the ratio of these 2 effects, $182 201 (95% UI: 181 494, 182 912) per HALE gained. Seventy-nine (60%) causes had an increase in mean HALE and lifetime spending. Value was $9315 (95% UI: 9204, 9427) for HIV/AIDS and $63 184 (95% UI: 62 352, 64 030) for ischemic heart disease. For drug use disorders, HALE effect was −0.331 (95%UI: −0.370, −0.296), which offset other gains. Increases in HALE often occur at older ages than lifetime spending.

Conclusions

Comprehensive measures for all ages show value of healthcare by cause.