Moving Beyond the QALY: Economic Evaluation in Health and Social Care for Elderly Populations

Abstract

The growing number of elderly consumes an increasing amount of health and social care services, straining public budgets. Economic evaluations have traditionally focused on curative care using health-related quality of life as outcomes, and gave answers which interventions to fund or not to fund. However in order to evaluate long-term care as well, broader outcomes are necessary. The aim of this thesis is to address a number of issues related to outcome measurement in economic evaluations in elderly populations consuming health and social care. After performing a traditional economic evaluation in long-term care and identifying the limitations, a systematic review was performed in order to search for more appropriate outcomes. The review identified the ICECAP-O instrument, and this has been validated in Dutch and German Nursing homes, as well as in a population of post-hospitalized older people. Finally, we have performed an economic evaluation using the ICECAP-O. The ICECAP-O in general measures broader than health outcomes. It was related to measures of health-related and dementia-specific quality of life, physical, mental and social health, and to wellbeing instruments. It also differentiates between elderly below and above 75 years, multimorbidity, dementia severity, living alone or together and elderly with nursing homes with or without physical restraints. In the cost-effectiveness analysis, the ICECAP-O yields a higher probability of cost-effectiveness than the EQ-5D. In elderly populations using both health and social care, outcome measures do make a difference for the cost-effectiveness of an intervention, and broader outcomes should be used. The ICECAP-O has been demonstrated to be useful for this purpose, however further research is necessary to confirm this. The results of thesis suggests, that policy makers should use wellbeing measures for resource allocation, at least in a population of elderly using both health and social care.