For this report, the Technology Evaluation Center, an AHCPR Evidence-based Practice Center of the Blue Cross and Blue Shield Association, conducted a systematic review of the evidence from randomized controlled trials on the relative effectiveness of alternative strategies for androgen suppression as treatment of advanced prostate cancer.

Prostate cancer is a disease of older men, and is second only to lung cancer in cancer mortality for men. For 1998, it was estimated that 184,500 new cases of prostate cancer would be diagnosed, and 39,200 men would die of prostate cancer that year.

In 1994, the total Medicare expenditure for treatment of prostate cancer was $1,411,687,900. Of the total, $477,851,000 was for androgen suppression therapy using luteinizing hormone-releasing hormone (LHRH) agonists. The prevalence of prostate cancer, and the expenditures for its treatment, are likely to increase with the aging of the population and the trend to earlier detection of the disease.

Three key issues are addressed in the report:

Two supplementary analyses were also conducted for each key question:

For over a decade, the National Bureau of Economic Research has sponsored the Economics of Aging Program, under the direction of David A. Wise. The program addresses issues that affect the well-being of individuals as they age and a society that is composed increasingly of older people.

Within the next twenty years, an unprecedented proportion of Americans will be over sixty-five. New research in the economics of aging is an essential element of understanding what the future holds for this aging population. Inquiries in the Economics of Aging presents both empirical papers that consider questions that are fundamental to public policy and more theoretical contributions that lay new groundwork for future research in the economics of aging.

Inquiries in the Economics of Aging provides a timely overview of some of the most important questions facing researchers on aging and outlines new techniques and models that may help to answer these questions. This important volume will be of great interest to specialists and policy makers as it paves the way for future analysis.

For over a decade, the National Bureau of Economic Research has sponsored the Economics of Aging Program, under the direction of David A. Wise. The program addresses issues that affect the well-being of individuals as they age and a society that is composed increasingly of older people.

Within the next twenty years, an unprecedented proportion of Americans will be over sixty-five. New research in the economics of aging is an essential element of understanding what the future holds for this aging population. Inquiries in the Economics of Aging presents both empirical papers that consider questions that are fundamental to public policy and more theoretical contributions that lay new groundwork for future research in the economics of aging.

Inquiries in the Economics of Aging provides a timely overview of some of the most important questions facing researchers on aging and outlines new techniques and models that may help to answer these questions. This important volume will be of great interest to specialists and policy makers as it paves the way for future analysis.

For over a decade, the National Bureau of Economic Research has sponsored the Economics of Aging Program, under the direction of David A. Wise. The program addresses issues that affect the well-being of individuals as they age and a society that is composed increasingly of older people.

Within the next twenty years, an unprecedented proportion of Americans will be over sixty-five. New research in the economics of aging is an essential element of understanding what the future holds for this aging population. Inquiries in the Economics of Aging presents both empirical papers that consider questions that are fundamental to public policy and more theoretical contributions that lay new groundwork for future research in the economics of aging.

Inquiries in the Economics of Aging provides a timely overview of some of the most important questions facing researchers on aging and outlines new techniques and models that may help to answer these questions. This important volume will be of great interest to specialists and policy makers as it paves the way for future analysis.

For over a decade, the National Bureau of Economic Research has sponsored the Economics of Aging Program, under the direction of David A. Wise. The program addresses issues that affect the well-being of individuals as they age and a society that is composed increasingly of older people.

Within the next twenty years, an unprecedented proportion of Americans will be over sixty-five. New research in the economics of aging is an essential element of understanding what the future holds for this aging population. Inquiries in the Economics of Aging presents both empirical papers that consider questions that are fundamental to public policy and more theoretical contributions that lay new groundwork for future research in the economics of aging.

Inquiries in the Economics of Aging provides a timely overview of some of the most important questions facing researchers on aging and outlines new techniques and models that may help to answer these questions. This important volume will be of great interest to specialists and policy makers as it paves the way for future analysis.

A population-based probability sample of elderly individuals (n = 426), who were originally studied between 1981 and 1986 (mean age at initial study was 72.5 years), were followed for mortality. Those with > or = 30 respiratory disturbances per hour of sleep had significantly shorter survival (p = 0.0034), but the respiratory disturbance index (RDI) was not an independent predictor of death. When Cox proportional hazards analysis was done, only age (the strongest predictor), cardiovascular disease and pulmonary disease were independent predictors of death. It may be that factors that are secondary to or associated with sleep-disordered breathing (SDB), such as cardiovascular or pulmonary disease, predispose these elderly to death.

This volume presents innovative research on issues of importance to the well-being of older persons: labor market behavior, health care, housing and living arrangements, and saving and wealth.

Specific topics include the effect of labor market rigidities on the employment of older workers; the effect on retirement of the availability of continuation coverage benefits; and the influence of the prospective payment system (PPS) on rising Medicare costs. Also considered are the effects of health and wealth on living arrangement decisions; the incentive effects of employer-provided pension plans; the degree of substitution between 401(k) plans and other employer-provided retirement saving arrangements; and the extent to which housing wealth determines how much the elderly save and consume.

Two final studies use simulations that describe the implications of stylized economic models of behavior among the elderly. This timely volume will be of interest to anyone concerned with the economics of aging.

Urinary incontinence affects 10 million elderly and is estimated to cost more than $10 billion annually. Treatments for this conditions vary widely in efficacy and cost. Using the Agency for Health Care Policy and Research urinary incontinence guideline, we calculated expected costs for three recommended treatments for stress urinary incontinence in elderly women: (1) behavioral therapy, (2) pharmacologic therapy, and (3) surgical therapy. We constructed decision trees for each treatment option and incorporated treatment efficacy rates stated in the guideline. Costs were determined from the literature.

Using a Markov cohort simulation, 10-year expected costs per patient, in 1994 dollars, were lowest for surgical therapies and were highest for behavioral therapy (needle suspension surgery, $25,388; phenlypropanolamine and estrogen, $62,021; and behavioral therapy, $68,924). All treatment strategies were less costly than that of untreated incontinence ($86,726). Sensitivity analysis revealed that the results were highly affected by the likelihood of the patient's entering a nursing home, the cost of nursing home care, and the long-term relapse rate after surgery.

In conclusion, on the basis of data from the urinary incontinence guideline, early surgical intervention is the least costly treatment for chronic stress incontinence in elderly women. Because the long-term effectiveness of most incontinence surgeries is uncertain, additional studies are necessary to substantiate these findings.