Upload
hacong
View
215
Download
0
Embed Size (px)
Citation preview
ESPEN Congress Lisbon 2015
Economic impact of Healthy AgeingC. Sieber (DE)
KEEP FIT FOR LIFE – NUTRITIONALAND FUNCTIONAL ENHANCEMENT OF OLDER ADULTS
ESPEN-Congress 2015 in Lisbon
Economic impact of Healthy Ageing
- personal perspective -
Cornel Christian SieberLehrstuhl Innere Medizin-Geriatrie
Friedrich-Alexander Universität Erlangen-NürnbergChefarzt Klinik für Allgemeine Innere Medizin und Geriatrie
Krankenhaus Barmherzige Brüder Regensburg
Healthy AgeingEU Project Definition
Healthy ageing is the process ofoptimising opportunities for physical, social and mental health to enableolder people to take an active part in society without discrimination and toenjoy an independent and good qualityof life.
Demographic change andEconomy
• Labour• Health• Family economics• Social security• Income distribution• Social mobility• Immigration• Productivity• Structural change• Economic growth• Development
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
Taxonomy
• Normal ageing exists
– Challenged by Aubrey de Grey
• Then, normal ageing must equal healthy ageing• Successful ageing then means mainly healthy
ageing• Intervention: To preserve healthy ageing or to
treat „unhealthy ageing or „abnormal ageing“
Adult Disability Dependency Ratio (ADDR)
• Classically, the age-quotient is given as: 65 vs 15-64 (years)
• Caveat: – Older adults today are longer healthy, take
over jobs more often and care for family, neighbours...
• ADDR takes instead of age per se the health status into acount
Sanderson and Scherbov. Science 2010;329:1287
Adult Disability Dependency Ratio (ADDR)
Classical age-quotient:• 2010: 33 (for 100 working persons, 33 are
retired)• 2050: 63ADDR:• 2010: 12 (for 100 persons, 12 are disabled)• 2050: 15
Sanderson and Scherbov. Science 2010:329;1287
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
Healthy AgeingEU Project Definition
Is health promotion for older people worthwhile?The usual cost-benefit model with consumption versus production discriminates against people with low incomes, such as pensioners. Including “senior production” (care of grand children, voluntary work etc) makes cost-effectiveness analyses fairer. Cost-benefit analyses of programmes relevant to older people indicate that the programmes lead to improved quality of life and decreased health care consumption. The potential health gains of a prevention programme are greater in the older population than among young people.
Healthy AgeingEU Project Definition
NutritionConsiderable gains in terms of mortality andfunction could be achieved if older peopleadopted a healthier lifestyle with healthyeating habits. Obesity and overweight areassociated with unhealthy dietary habits andlack of physical activity
Changes in life-expectancies - 1
• Age 65, year 2012:– 18.6 y for men– 21.1 y for women
• Age 65, year 2050:– 20.1 for men– 24.6 for women
The older you are, the older you
get
Changes in life-expectancies - 2
• When associated with improvement in underlying health, additional life expectancy gains only have a limited effect on expenditure growth.
• Elderly „healthy“ persons are a substantial driver for investments and production of healthcare goods.
Modeling health and health careexpenditures
• Population ageing is partly result of rise in life expectancy
• Time-to-death studies take this intoaccount, and find a slower increase in healthcare costs increase (mortalityfunctions as proxy to health)
• So, expenditures seem only to bepostponed later in life
Der SPIEGEL
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
Modeling health and health careexpenditures
Expansion of Morbidity scenario
versus
Compression of Morbidity scenario
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
0 1 2 3 4
No disability - no comorbidityNo disability - comorbidity (2 diseases)No disability - comorbidity (3+ diseases)Disability - no comorbidityDisability - comorbidity (2 diseases)Disability - comorbidity (3+ diseases)
Years
Surv
ival
rate
No disabilityDisability
Disability – more than multimorbidity – determines mortality in persons >80 years of age
Landi F et al. J Clin Epidemiol 2010;63:752-758
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
Cost-efffectiveness and QALY
Success: Gain in quality-adjustedlife-years
Calculation of one life-year in relation to health:
–QALY of 1 equals oneyear in completephysical andpsychological health–1 year with a QoL of50% means: 1 x 0.5 = 0.5 QALY
QALY = Lifetime x Quality of Life
herkömmliche oder keine
Behandlung
Cost-effectiveness of a 3-months oral Supplement in N=120 malnourished persons with a non-malignant disease
3 months intervention with protein- and
energy-rich supplement
+ 0.045 QALYs = 16 days 100% Quality
of Life
Norman K et al. Eur J Clin Nutr 2011;65(6):735-42
Economics of proteinsupplementation
• The available economic evidenceindicates that protein and energysupplementation in treatment orprevention of malnutrition providesan opportunity to improve patientwellbeing and lower health systemcosts.
Milte RK et al. Eur J Clin Nutr 2013;67:1243-1250
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
Choosing Wisely
• In 2012 the ABIM Foundation launched Choosing Wisely® with a goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.
• Germany (German Society of Internal Medicine = DGIM): Also „underuse“
(ABIM = American Board of Internal Medicine)
Choosing Wisely Geriatrics(American Geriatrics Society)
• Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.– O.k. with our guidelines
• Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults; instead, optimize social supports, discontinue medications that may interfere with eating, provide appealing food and feeding assistance, and clarify patient goals and expectations.– Not o.k. with our guidelines
Choosing Wisely and economics
If we would not treat healthy persons, but instead really would treat thosewho need it (not healthy), we would
make a real economic change in healthcare expenditures
Menue
• Healthy Ageing – the framework• Costs to promote Healthy Ageing• Costs of loss of Healthy Ageing• Healthy Ageing and QALY‘s• Choosing Wisely Initiative• THM
THM
• Economics of Healthy Ageing have to balanceexpenditures with income/investments, independent of QoL
• Demographic change does not per per se increase health economics
• Out of the trias to promote Healthy Ageing andthereby longevity, nutrition seems to be theeasiest one to tackle (compared to physicalactivity and social contacts)