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 |