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 .
Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care.
BACKGROUND Regular physical activity ( PA ) reduces the risk of falls and hip fractures , and mortality from all causes . However , PA levels are low in the older population and previous intervention studies have demonstrated only modest , short-term improvements . OBJECTIVE To evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years . DESIGN The ProAct65 + study was a pragmatic , three-arm parallel design , cluster r and omised controlled trial of class-based exercise [ Falls Management Exercise ( FaME ) programme ] , home-based exercise [ Otago Exercise Programme ( OEP ) ] and usual care among older people ( aged ≥ 65 years ) in primary care . SETTING Forty-three UK-based general practice s in London and Nottingham/Derby . PARTICIPANTS A total of 1256 people ≥ 65 years were recruited through their general practice s to take part in the trial . INTERVENTIONS The FaME programme and OEP . FaME included weekly classes plus home exercises for 24 weeks and encouraged walking . OEP included home exercises supported by peer mentors ( PMs ) for 24 weeks , and encouraged walking . MAIN OUTCOME MEASURES The primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity ( MVPA ) per week , 12 months after cessation of the intervention . Secondary outcomes included functional assessment s of balance and falls risk , the incidence of falls , fear of falling , quality of life , social networks and self-efficacy . An economic evaluation including participant and NHS costs was embedded in the clinical trial . RESULTS In total , 20,507 patients from 43 general practice s were invited to participate . Expressions of interest were received from 2752 ( 13 % ) and 1256 ( 6 % ) consented to join the trial ; 387 were allocated to the FaME arm , 411 to the OEP arm and 458 to usual care . Primary outcome data were available at 12 months after the end of the intervention period for 830 ( 66 % ) of the study participants . The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40 % to 49 % in the FaME arm , from 41 % to 43 % in the OEP arm and from 37.5 % to 38.0 % in the usual-care arm . A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [ adjusted odds ratio ( AOR ) 1.78 , 95 % confidence interval ( CI ) 1.11 to 2.87 ; p = 0.02 ] . There was no significant difference in MVPA between OEP and usual care ( AOR 1.17 , 95 % CI 0.72 to 1.92 ; p = 0.52 ) . Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level . In the 12 months after the close of the intervention phase , there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm ( incidence rate ratio 0.74 , 95 % CI 0.55 to 0.99 ; p = 0.042 ) . Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care , as did perceptions of benefits from exercise . Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm . There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes , including quality -adjusted life-years  . FaME is more expensive than OEP delivered with PMs ( £ 269 vs. £ 88 per participant in London ; £ 218 vs. £ 117 in Nottingham ) . The cost per extra person exercising at , or above , target was £ 1919.64 in London and £ 1560.21 in Nottingham ( mean £ 1739.93 ) . CONCLUSION The FaME intervention increased self-reported PA levels  among community-dwelling older adults 12 months after the intervention , and significantly reduced falls . Both the FaME and OEP interventions appeared to be safe , with no significant differences in adverse reactions between study arms . TRIAL REGISTRATION This trial is registered as IS RCT N43453770 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 18 , No. 49 . See the NIHR Journals Library website for further project information
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 .