Open Access

Abstract Background Vertigo, dizziness and balance disorders affect over half of adults aged 65 and older. The MobilE-PHY2 study, conducted in Germany, evaluated the effectiveness of an evidence-based, multidisciplinary care pathway for this population. From a health economic perspective, the intervention was expected to increase outpatient and physiotherapy costs while reducing resource utilisation in other healthcare areas and improving patient-relevant outcomes. Objective This health economic evaluation examined the cost-effectiveness of the care pathway compared to optimised routine care. Incremental costs were related to incremental changes in both quality-adjusted life years (QALYs) and the Dizziness Handicap Inventory (DHI) as a disease-specific outcome; expressed as incremental cost-effectiveness ratios (ICER). Methods The study was a multicentre, cluster-randomised controlled trial with six -month follow-up. The health economic evaluation was conducted from a societal perspective. Cost-effectiveness was determined via incremental cost-utility ratios (ICURs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using cost-effectiveness acceptability and net-monetary-benefit curves. Missing data were handled using Multiple Imputation by Chained Equations. Sensitivity analyses excluded informal care costs and focused on a subgroup with reduced imputation uncertainty. Results The ICER was 81,246.85€ per additional patient achieving a clinically relevant DHI improvement. Indicating that if the willingness-to-pay threshold were €50,000 per additional patient achieving a clinically relevant DHI improvement, the intervention would be cost-effective with 71% probability. The ICUR was negative (-121,847.54€/QALY), meaning optimised routine care dominated the intervention. From a payer perspective, the intervention was less costly, though with lower QALYs. Findings were robust in sensitivity analyses. Conclusion The care pathway shows potential for cost-effectiveness among patients achieving DHI improvements, supporting cautious, targeted implementation in routine care. Future research should address the economic burden on informal caregivers. Trial registration DRKS00028524 retrospectively registered on March 24, 2022.