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Table 1 Synoptic table of challenges concerning the economic evaluation of health promotion activities for older people

From: Economic evaluation of health promotion for older people-methodological problems and challenges

Synoptic table of problems concerning the economic evaluation of health promotion activities for older people

To differentiate the different aspects,

 - general problems of health economic evaluations are in normal lettering;

 - aspects that arise mainly from the specific nature of health promotion are presented in italics,

 - aspects that gain special importance for older people are in bold

Societal perspective recommended (in some countries generally required)

Attribution of effects

 - Long time horizon (but shorter effective period for older people)

 - RCTs are difficult to implement

 - influence of third variables is increased;

 - Long term outcomes have to be estimated

Measuring and valuing of outcomes

 - Multiple endpoints

 - Long causal chains (use of proxy outcomes)

 - Social benefits and non-health targets gain importance

 - Intersectoral consequences

 - Diverging preference structures of older people

 - Cost-utility analysis and cost-benefit analysis may imply age based rationing

Identification, measurement of costs

 - Measurement and valuation of informal caregiver time

 - Measurement and valuation of productivity costs (including unpaid labour)

 - Costs incurred in added years of life

 - intersectoral costs

Equity considerations

Discounting of benefits reduces effectiveness results

Increased level of uncertainty

Choice of comparator is difficult

Context-sensitivity – limited transferability