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Medical Decision Making
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The GAME Estimate of Reduced Life Expectancy

Wilbert B. van den Hout, PhD

Department of Medical Decision Making, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlandshout{at}lumc.nl

The Declining Exponential Approximation of Life Expectancy (DEALE) is a simple method of estimating the impact of excessmortality on life expectancy, but it can lead to considerable bias due to the implicit constant baseline and excess mortality rates. This article presents a new method that does not use constant mortality rates. The variability of the baseline mortality is modeled using gamma (GA) distributions. Excess mortality rates are modeled using mixed-exponential (ME) distributions, which is appropriate if the excessmortality rate is nonincreasing, convex, and smooth. The new gamma mixed-exponential (GAME) estimate is convenient enough to replace the DEALE in formal decision analyses. The error from assuming gamma distributions for the Dutch baseline mortality was shown to be less than 2 months and typically about 1 month. Therefore, the GAME estimate is accurate enough to replace more elaborate methods, provided themixed-exponential model is an appropriatemodel for the excess mortality.

Key Words: DEALE • life expectancy • survival • mortality

Medical Decision Making, Vol. 24, No. 1, 80-88 (2004)
DOI: 10.1177/0272989X03261564
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