Table 3.

The solutions of indicated problems suggested in the studies

Type of problem	Potential solution	Remarks
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, 30–33, 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].

Authors’ indication of a potential solution does not always mean that they consider it a recommendation