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Table 3 Risk factors for age discrimination in the economic evaluation of health promotion for older people

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

Methodological options Potential discriminatory effects for older people
If … the effect will be ….
the perspective of the study is partial, societal benefits are underestimated; for older people e.g. reduced costs for long-term care.
informal caregivers time and other informal care costs are excluded, benefits of interventions that aim at the reduction of dependency on long-term care are underestimated.
productivity costs are included without considering unpaid work, societal value of senior’s unpaid work is neglected (informal care, volunteer work, household work).
cost incurred in added years of life unrelated to the interventions are included, life-prolonging interventions for older people will be rated less cost effective, because older people will produce more costs in near future due to comorbidities.
effects are measured by natural parameters (CEA), social benefits that are more important for older people are not covered.
effects are measured by QALYs (CUA), benefits of interventions for older people will be underestimated, because
… preferences of older people, especially social benefits are not covered.
… a lower life expectancy results in less QALYs gained.
benefits are valued as monetary outcomes by willingness-to-pay (CBA), results will be biased depending on distributive effects on the respondent, interventions for older people may be rated poorly if respondents are younger people.
benefits are valued monetarily without subjective elements (CBA), benefits of the intervention will be underestimated, because social benefits are especially important for older people.