Gains in life expectancy from medical interventions - Standardizing data on outcomes

Background The gain in life expectancy is an important measure of the effectiveness of medical interventions, but its interpretation requires that it be placed in context. The interpretation of gains in life expectancy is particularly problematic for preventive interventions, for which the gains are often just weeks or even days when averaged across the entire target population. Methods We tabulated the gains in life expectancy from a variety of medical interventions as reported in 83 published sources and categorized them according to target population and disease. We considered prevention in populations at average risk for particular diseases, prevention in populations at elevated risk, and treatments in populations with established disease. Results The gains in life expectancy from preventive interventions in populations at average risk ranged from less than one month to slightly more than one year per person receiving the intervention, but the gains were as high as five yea rs or more if the prevention was targeted at persons at especially high risk. The gains in life expectancy from treatments of established disease ranged from several months (for coronary thrombolysis and revascularization to treat heart disease) to as long as nine years (for chemotherapy to treat advanced testicular cancer). Conclusions A gain in life expectancy from a medical intervention can be categorized as large or small by comparing it with gains from other interventions aimed at the same target population. A gain in life expectancy of a month from a preventive intervention targeted at populations at average risk and a gain of a year from a preventive intervention targeted at populations at elevated risk can both be considered large. The framework we developed for standardizing gains in life expectancy can be used in the interpretation of data on the outcomes of interventions. (N Engl J Med 1998;339:380-6.) (C)1998, Massachusetts Medical Society.