Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges?

Abstract

BackgroundIn the light of demographic developments health promotion interventions for older people are gaining importance. In addition to methodological challenges arising from the economic evaluation of health promotion interventions in general, there are specific methodological problems for the particular target group of older people. There are especially four main methodological 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 methodological requirements are actually met in applied health economic evaluations.MethodsFollowing a systematic review of pertinent health economic evaluations, the included studies are analysed on the basis of four assessment criteria that are derived from methodological debates on the economic evaluation of health promotion interventions in general and economic evaluations targeting older people in particular.ResultsOf the 37 studies included in the systematic review, only very few include cost and outcome categories discussed as being of specific relevance to the assessment of health promotion interventions for older people. The few studies that consider these aspects use very heterogeneous methods, thus there is no common methodological standard.ConclusionThere is a strong need for the development of guidelines to achieve better comparability and to include cost categories and outcomes that are relevant for older people. Disregarding these methodological 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.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0100-4) contains supplementary material, which is available to authorized users.

Methodological issues in economic evaluations of disease prevention and health promotion: an overview of systematic and scoping reviews

“…1 ) [ 5 , 19 , 23 – 31 ] Excluded reviews are shown in Additional file 4 . Of the included reviews (Table 1 ), five addressed different preventive measures for older people [ 25 , 27 ] or children/adolescents [ 26 , 28 , 30 ], while the others targeted physical activity [ 23 ], implementation of DPHP [ 24 ], alcohol prevention [ 31 ], behavior change [ 5 ], injury prevention [ 29 ], or different areas of prevention [ 19 ]. Overall, these reviews included 494 economic analyses (CEA: 42%, CUA: 20%, different types of economic study: 16%, CCA: 15%, CBA: 6%, CMA: 1%.…”

“…security: 57% - other: 18% Perspective : - societal: 84% - health sector: 8% - not stated: 8% n.a. Huter et al (2018) [ 25 ] a DPHP-interventions for older people n = 8 CEA = 25% CUA = 25% Different types = 50% TBA/MBA: n = 4/4 Time horizon all : - ≤ 2y: 75% - lifetime: 13% TBA : ≤ 2y 100% MBA : lifetime 25% Intermediate HO : all studies (e.g., falls, physical activity) HO/PbO : 88% (fall-related fractures, QALYs) Non-HO : 13% (social benefits such as ‘general self-efficacy’, ‘well-being’, or ‘loneliness’) Categories : − labor/soc. security: n.a.…”

“…The reviews raised concerns about an often incomplete reporting of both health sectoral costs and inter-sectoral costs. Moreover, several reviews addressed inconsistencies in the cost analysis process, such as the usage of different approaches to classify, measure and value the same cost categories [ 5 , 24 , 25 , 27 ].…”

“…While concerns of equity were not addressed in almost half of the reviews [ 24 , 26 , 28 – 30 ], the authors of five reviews concluded that equity considerations were usually disregarded in economic studies [ 5 , 19 , 25 , 27 , 31 ]. In particular, Alayli-Goebbels et al (2014) [ 5 ] noted that the impact on equity was not examined at all, neither by using equity-weighted utilities nor by calculating cost-effectiveness ratios for different socio-economic groups.…”

Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic

“…Productivity loss was calculated based on an income loss of CAD 29.55/hour [28] over the time calculated for an average clinic visit [29], return travel time, and estimate of time for parking and finding the clinic (2.53 h). Productivity loss was only evaluated for patients <65 years old, comprising 23% of MDC patients (79/350) [30,31]. Given 371 fewer visits in MDC, this resulted in patient productivity loss reduction of CAD 6,379.…”