Modelling long-term cost-effectiveness of health promotion for community-dwelling older people

Magnus Zingmark,Lars Lindholm,Synneve Dahlin-Ivanoff,Susanne Gustafsson,Fredrik Norström

doi:10.1007/s10433-019-00505-1

Magnus Zingmark, Lars Lindholm + Show 3 more

Open Access

https://doi.org/10.1007/s10433-019-00505-1

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Abstract

The effectiveness of health promotion for community-dwelling older people is well documented; however, there is a general lack of health economic evaluations. The aim of the present study was to evaluate long-term cost-effectiveness over 4 years of two health promoting interventions: senior meetings and a preventive home visit, for community-dwelling older people in relation to no intervention. We applied a Markov model including five states defined in relation to level of dependency of home help and place of residency. The model included transitions between dependency states, scores for quality of life and societal costs for each state, intervention costs and intervention effects for two formats of health promoting interventions. For each intervention and a no-intervention control group, we calculated the accumulated quality-adjusted life years (QALYs) and societal costs over 4 years. Sensitivity analyses included higher intervention costs, lower intervention effects and additional intervention costs and effects related to booster sessions. The results of all analyses indicated that health promotion implemented for community-dwelling older people in the format of senior meetings or a preventive home visit was cost-effective. Both interventions lead to QALY gains and reduce societal costs at any follow-up over 4 years, and thus, resources can be used to implement other interventions. The most important factor for the magnitude of QALY gains and cost savings was the intervention effect. Yearly booster sessions implemented for those persons who maintained their level of functioning extended the intervention effects adding additional QALYs and further reducing societal costs.

Highlights

Health promotion for community-dwelling older people has the potential to positively affect various facets of functioning, health and independence (Beswick et al 2008)
The senior meetings resulted in 0.054 quality-adjusted life years (QALYs) gained over 4 years and lower societal costs amounting to 2283 €
The preventive home visit resulted in 0.048 QALYs gained over the same time period and lower societal costs amounting to 2091 €

Summary

Introduction

Health promotion for community-dwelling older people has the potential to positively affect various facets of functioning, health and independence (Beswick et al 2008). In a recent trial, three formats of health promoting occupational therapy (i.e. discussion group, activity group and individual intervention) were found to result in better effects than no intervention (Zingmark et al 2014). Given the results of recent trials (Gustafsson et al 2012, 2013; Zingmark et al 2014), it seems as if health promotion for community-dwelling older people may include only a few sessions and still be effective. Thereby, interventions may be implemented at a relatively low cost, especially since a group format seems to result in positive effects on a broader range of outcomes than an individual format (Gustafsson et al 2012; Zingmark et al 2014). Since a persons’ functional level is associated with both healthrelated quality of life (HRQoL) and societal costs (Lindholm et al 2013), it is important to consider the costeffectiveness of interventions

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