The report is a product of the VA/HSR Evidence Synthesis Program.

Life Expectancy Calculators

Estimation of life expectancy serves an important role in clinical decisions about screening for disease and treatment in primary care practices. Increasingly, clinical guidelines recommend a course of action in context of the patient's life expectancy. While many tools have been developed to estimate life expectancy or the likelihood of surviving for a period of time, there are no well-established decision support tools that are broadly applicable to primary care. For a life expectancy calculator to gain widespread use in primary care, it needs to have acceptable and validated predictive accuracy at decision-relevant times such as six months or five years, proven usefulness, and be readily available.

This systematic review updated the literature search on life expectancy calculators. More specifically, a life expectancy decision support tool would be electronically implemented to provide quantitative survival estimates to VA primary care providers who, along with their patients, would use the estimates when making healthcare decisions, thereby improving patient outcomes and healthcare value. Investigators with VA's Evidence-based Synthesis Program Center located in Minneapolis, Minnesota searched MEDLINE from 2011 to May 2016, limiting the search to studies in English and those that focused on individuals aged 45 years and older. From 51 studies selected for full review, 11 were selected to address key questions in this report.

Summary of Review
Although healthcare providers and guidelines make recommendations based, in part, on assessments of life expectancy, there is no widely accepted statistical tool for estimating patients' life expectancy or probability of survival, particularly for prolonged periods (e.g., 5 to 10 years). Moreover, these calculators need to be validated for use in primary care practices. Models described in the existing literature were developed for different purposes, including:

• Development of individual risk scores to adjust for possible difference in mortality risk when comparing healthcare outcomes;
• Helping primary care teams assess short-term risk of hospitalization or death without hospitalization;
• Helping healthcare providers judge whether patients will or won't die within a specified time pertinent to decisions about screening for cancer.

If a life expectancy calculator is made available, it remains to be determined whether primary care providers would use it – or whether it would improve healthcare delivery, resource use, patient experiences, or outcomes.

Future Research
Research on the clinical usefulness and impact of mortality prediction models on clinical decisions and outcomes is needed to guide further development and engender widespread acceptance for a tool that estimates patients' life expectancy or probability of survival. Analytical life expectancy predictions have to be demonstrated to be more accurate than clinicians' intuitive prognostic assessments, preferably using statistics that allow clinicians to compare prognostic errors. Additionally, they should use patient information that is readily and reliably available. Strong comparative evidence that using a quantitative prediction model can reduce practice variation and improve healthcare decisions and outcomes most likely will be needed to change current practices.

Reference
Rector T, Taylor BC, Sultan S, Shaukat A, Adabag S, Nelson D, Capecchi T, MacDonald R, Greer, N, Wilt TJ. Life Expectancy Calculators, VA ESP Project #09-009;2016.

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This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.

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