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

Background: In 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. Methods: Following 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. Results: Of 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. Conclusion: There 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

Health promotion and prevention for older people. Challenges and limits of health economic evaluation

Die kumulative Dissertation arbeitet heraus, ob und in welcher Form gesundheitsökonomische Evaluationen ein angemessenes Mittel sind, um Entscheidungsträger:innen bei der Allokation von Ressourcen für Gesundheitsförderungsaktivitäten für ältere Menschen zu unterstützen. Im Fokus der vier Fachartikel stehen (1.) die besonderen methodologischen Herausforderungen bei der ökonomischen Evaluation entsprechender Interventionen, (2.) ein systematisches Review zur bisher vorliegenden gesundheitsökonomischen Evidenz, (3.) die Analyse, wie in den vorliegenden Evaluationen mit den methodologischen Herausforderungen umgegangen wird, und (4.) die Möglichkeiten im Rahmen der gesundheitsökonomischen Evaluation gerechtigkeitsbezogene Fragen zu berücksichtigen. Im Rahmenpapier wird der Blick darüber hinaus auf ethische Positionen zur Altersdiskriminierung im Kontext der Gesundheitsökonomie erweitert. Konsequenzen für eine mögliche Entscheidungsunterstützung für die Ressourcenallokation werden sowohl in den Einzelarbeiten als auch im Rahmenpapier diskutiert. Zudem werden Primärprävention und Gesundheitsförderung für ältere Menschen im deutschen Gesundheitssystem verortet und die Rolle, die der gesundheitsökonomischen Evaluation von Interventionen bisher zukommt, diskutiert. Die Arbeit zeigt, dass es erhebliche Herausforderungen bei der gesundheitsökonomischen Evaluation von Gesundheitsförderung für Ältere gibt, die dazu führen, dass die Vergleichbarkeit der Ergebnisse mit kurativen Interventionen oder Interventionen für jüngere Altersgruppen erheblich eingeschränkt ist. Eine Nichtberücksichtigung kann zu einer methodenimmanenten Benachteiligung Älterer führen. Für den Vergleich unterschiedlicher Interventionen innerhalb einer Altersgruppe kann die gesundheitsökonomische Evaluation jedoch ein sehr hilfreiches Unterstützungsinstrument darstellen. Aufgezeigt wird auch, dass es ein sich gut entwickelndes Methodenrepertoire gibt, um gerechtigkeitsbezogene Fragestellungen in gesundheitsökonomischen Evaluationen zu adressieren

Health economic evaluation of digital nursing technologies: A review of methodological recommendations

Background: Health economic evaluation of digital nursing technologies (DNT) is important to provide information that helps avoid undesirable developments and implementations as well as increase the chances of success of developed applications. At the same time, studies and evidence on cost-effectiveness are still very rare in this field. Review studies in related technology areas such as telemedicine frequently criticise the quality and comparability of health economic evaluations conducted in this field. Based on a content analysis of methodological literature on the economic evaluation of innovative (digital) technologies in health and nursing, this article aims to identify specific challenges in this research area and offers recommendations on how to address these challenges to promote more sound health economic evaluations in the future. Methods: A rapid review was conducted, consisting of a systematic search in the Pubmed database as well as Google Scholar. In addition, the literature lists of the analysed texts were scoured for additional texts to be included. Methodological literature, single studies, and reviews were included. A total of 536 studies were screened, of which 29 were included in the full text analysis. Results: Based on the systematic content analysis of the studies under consideration, 10 specific methodological challenges are identified, and the methodological recommendations were examined for consideration. A particular focus was given to whether specific methodological approaches might be needed in the context of evaluating the efficiency of DNT. Conclusion: Many of the challenges identified for the health economic evaluations of digital nursing technologies are comparable to those of other complex health care interventions. The recommendations discussed can help to alleviate those challenges. Future research should focus on alternative approaches to assessing causality in different phases of technology development while maintaining high evidence standards. High-evidence economic assessment of technologies in nursing care should be carried out in routine use, especially if they are intended to be reimbursed by the social insurance

Healthy ageing in Germany–common care and insurance funding.:Institutional and financial dimension of health promotion for older people

In Germany responsibilities for health promotion and prevention lies with a multitude of different actors and institutions. The institutional arrangement of health promotion is shaped by the German federal structure of the state on the one hand and by a health care system that is characterized by divided responsibilities between governmental organisations, self-administered bodies and non-governmental organisations on the other hand. Although federal-level programs are successfully implemented in the country, the attempt of the Federal government to consolidate and clarify responsibilities in the public health area meets resistance. The Preventive Health Care Act from 2015 is an attempt to strengthen health promotion, its effective impact will be for the future to show. Health promotion activities are initiated and provided by a variety of institutions: governmental, self-administered and voluntary (NGOs) often based on networks form. They cover activities on federal, Länder and local level. The Federal Ministry of Health and federal health agencies (specially BZgA) play an important role in this field. They created a number of health promotion regulation and activities initiatives which added to disease and addiction prevention. In health promotion for older people (HP4OP) programs, there is also a number of regionally and locally oriented initiatives.In this paper, we outline main features of the HP4OP activities in Germany with regard to institutions and financing mechanism. In addition, we describe health-targeting programmes/projects indicated as good practices:(a) established and developed in Germany and (b) provided by the European Commission with significant participation of German institutions. The multitude and variety of HP4OP programs differentiate positively German health system from other health systems in ageing countries

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

Abstract Background In 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. Methods Following 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. Results Of 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. Conclusion There 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

MOESM1 of Economic evaluation of health promotion interventions for older people: do applied economic studies meet the methodological challenges?

Additional file 1: Table S1. Tabular summary of results. The table contains the results of the assessment of the four criteria specific for interventions targeting older people, some general characteristics and results of the general quality assessment of the studies included in the systematic review and its update

Health Promotion for Older People in Europe : health promoters and their activities Knowledge for training

This handbook on health promotion addressed to older people, which is written for readers in European countries, should function as a training programme guideline for health promoters. The authors are aware that it is an excessively ambitious task in light of the relatively poor scientific state of affairs in the field of health promotion. This ambition may be justified to some extent by the experience of the writing team, who acquired a considerable capital of knowledge as a result of ‘Pro health 65+’ - the European project on health promotion addressed to elderly people and prevention of chronic diseases, which was carried out as a part of the second Health Programme of the European Union