Huter Kai, Kocot Ewa, Kissimova-Skarbek Katarzyna, Dubas-Jakóbczyk Katarzyna, Rothgang Heinz
SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.
High-profile area Health Sciences, University of Bremen, Bremen, Germany.
BMC Health Serv Res. 2016 Sep 5;16 Suppl 5(Suppl 5):328. doi: 10.1186/s12913-016-1519-y.
The support of health promotion activities for older people gains societal relevance in terms of enhancing the health and well-being of older people with a view to the efficient use of financial resources in the healthcare sector. Health economic evaluations have become an important instrument to support decision-making processes in many countries. Sound evidence on the cost-effectiveness of health promotion activities would encourage support for the implementation of health promotion activities for older people. This debate article discusses to what extent economic evaluation techniques are appropriate to support decision makers in the allocation of resources regarding health promotion activities for older people. We address the problem that the economic evaluation of these interventions is hampered by methodological obstacles that limit comparability, e.g. with economic evaluations of curative measures. Our central objective is to describe and discuss the specific problems and challenges entailed in the economic evaluation of health promotion activities especially for older people with regard to their usefulness for informing decision making processes.
Beyond general problems concerning the economic evaluation of health promotion, our discussion focusses on problems that pertain to the analysis of cost and outcomes of health promotion interventions for older people. With regard to costs these are general problems of economic evaluations, namely the actual implementation of a societal perspective, the appropriate measurement and valuation of informal caregiver time, the measurement and valuation of productivity costs and costs incurred in added years of life. The main problems concerning the identification and measurement of outcomes are related to the identification of outcome parameters that, firstly, adequately reflect the broad effects of health promotion interventions, especially social benefits that gain importance for older people, and secondly, ensure a comparability of effects across different age groups. In particular, the limitations of the widely used QALY for older people are discussed and recently developed alternatives are presented.
The key conclusion of the article is that a comparison of the effects of different health promotion initiatives between different age groups by means of economic evaluation is not recommendable. Taking into account the complex outcomes of health promotion interventions it has to be accepted that the outcomes of these interventions will often not be comparable with clinical interventions and have to be assessed differently.
从提高老年人健康水平和福祉的角度出发，以有效利用医疗保健部门的财政资源为目的，对老年人健康促进活动的支持具有社会意义。健康经济评估已成为许多国家支持决策过程的重要工具。关于健康促进活动成本效益的可靠证据将鼓励支持开展老年人健康促进活动。这篇辩论文章讨论了经济评估技术在多大程度上适合支持决策者在老年人健康促进活动资源分配方面的决策。我们探讨了这样一个问题，即这些干预措施的经济评估受到方法学障碍的阻碍，这些障碍限制了可比性，例如与治疗措施的经济评估相比。我们的核心目标是描述和讨论健康促进活动经济评估中所涉及的具体问题和挑战，特别是对于老年人而言，这些问题和挑战对于为决策过程提供信息的有用性。
除了健康促进经济评估的一般问题外，我们的讨论重点关注与老年人健康促进干预措施成本和结果分析相关的问题。关于成本，这些是经济评估的一般问题，即社会视角的实际应用、非正式照护者时间的适当测量和估值、生产力成本的测量和估值以及增加生命年所产生的成本。关于结果识别和测量的主要问题与结果参数的识别有关，首先，这些参数要充分反映健康促进干预措施的广泛影响，特别是对老年人来说变得重要的社会效益，其次，要确保不同年龄组之间效果的可比性。特别是，讨论了广泛使用的质量调整生命年对老年人的局限性，并介绍了最近开发的替代方法。
本文的关键结论是，不建议通过经济评估对不同年龄组之间不同健康促进举措的效果进行比较。考虑到健康促进干预措施的复杂结果，必须承认这些干预措施的结果往往与临床干预措施不可比，必须进行不同的评估。
