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 .
Cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people: Results of a cluster randomized trial
Objective To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care . Methods We conducted cost-effectiveness and cost-utility analyses alongside a cluster r and omized trial with one-year follow-up . Participants were aged ≥ 70 years and at increased risk of functional decline . Participants in the intervention group ( n = 1209 ) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits . The control group ( n = 1074 ) received usual care . Costs were assessed from a healthcare perspective . Outcome measures included disability ( modified Katz-Activities of Daily Living ( ADL ) index score ) , and quality -adjusted life-years ( QALYs ) . Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios ( ICERs ) was estimated using bootstrapped bivariate regression models while adjusting for confounders . Results There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups . Total mean costs were significantly higher in the intervention group ( EUR 6518 ( SE 472 ) compared with usual care ( EUR 5214 ( SE 338 ) ; adjusted mean difference € 1457 ( 95 % CI : 572 ; 2537 ) . Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay ( WTP ) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained . Conclusion The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period . Based on these findings , implementation of the evaluated multifactorial nurse-led care model is not to be recommended
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 .