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 Analysis of Primary Care‐Based Physical Activity Counseling in Older Men: The VA‐LIFE Trial
OBJECTIVES To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans . DESIGN Secondary objective of r and omized trial that assessed the effect of exercise counseling ( relative to usual care ) on physical performance , physical activity , function , disability , and medical re source use and cost . SETTING Veterans Affairs Medical Center , Durham , North Carolina . PARTICIPANTS Male veterans aged ≥70 years ( n = 398 ) . INTERVENTION An experienced health counselor provided baseline in-person exercise counseling , followed by telephone counseling at 2 , 4 , and 6 weeks , and monthly thereafter through one year . Each participant 's primary care physician provided initial endorsement of the intervention , followed by monthly automated telephone messages tailored to the patient . Individualized progress reports were mailed quarterly . MEASUREMENTS Intervention costs were assessed . Health care re source use and costs were estimated from enrollment through one year follow-up . The incremental cost of achieving clinical ly significant changes in major trial endpoints was calculated . RESULTS The total direct cost of the intervention per participant was $ 459 , 85 % of which was counselor effort . With overhead , program cost totaled $ 696 per participant . Medical costs during follow-up reached $ 10,418 with the intervention , versus $ 12,052 with usual care ( difference = -$1,634 ( 95 % confidence interval = -$4,683 to $ 1,416 ; P = .29 ) ) . Expressed in terms of short-term clinical outcomes , the intervention cost $ 4,971 per additional patient reaching target exercise levels , or $ 4,640 per patient achieving a clinical ly significant change in rapid gait speed . CONCLUSION Improvements in physical activity and rapid gait speed  in the physical activity counseling group were obtained at a cost that represents a small fraction of patients ' annual health care costs
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 .