Disregarding these method ological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and , hence , an age-based rationing of public health care
Background In the light of demographic developments health promotion interventions for older people are gaining importance .
In addition to method ological challenges arising from the economic evaluation of health promotion interventions in general , there are specific method ological problems for the particular target group of older people .
There are especially four main method ological challenges that are discussed in the literature .
They concern measurement and valuation of informal caregiving , accounting for productivity costs , effects of unrelated cost in added life years and the inclusion of ‘ beyond-health ’ benefits .
This paper focuses on the question whether and to what extent specific method ological requirements are actually met in applied health economic evaluations .
Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population
Background Falls among older people are of growing concern globally . Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades . The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective , of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population . Methods A decision analysis using a decision tree model was based on the results of a previously published r and omised controlled trial with a community-dwelling population aged over 70 .  Measures of falls , fall-related injuries and re source use were directly obtained from trial data and supplemented by literature -based utility measures . A sub-group analysis was performed of women only . Cost estimates are reported in 2010 British Pound Sterling ( GBP ) . Results The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £ 30,000 per QALY , but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY . The ICER value at 95 % confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis . Males had a 44 % lower injury rate if they fell , compared to females result ing in a more favourable ICER for the women only analysis . For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation . The ICER value at 95 % confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis . The base case incremental cost per fall averted was GBP£652 ( GBP£616 for women only ) . A threshold analysis indicates that this exercise program can not realistically break even . Conclusions The results suggest that this exercise program is cost-effective for women only . There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal . Conservative assumptions may have underestimated the true cost-effectiveness of the program
Disregarding these method ological obstacles could implicitly lead to discrimination against the elderly in terms of health promotion and disease prevention and , hence , an age-based rationing of public health care
Background In the light of demographic developments health promotion interventions for older people are gaining importance .
In addition to method ological challenges arising from the economic evaluation of health promotion interventions in general , there are specific method ological problems for the particular target group of older people .
There are especially four main method ological challenges that are discussed in the literature .
They concern measurement and valuation of informal caregiving , accounting for productivity costs , effects of unrelated cost in added life years and the inclusion of ‘ beyond-health ’ benefits .
This paper focuses on the question whether and to what extent specific method ological requirements are actually met in applied health economic evaluations .