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Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

Holtzer-Goor KM, Gaultney JG, van Houten P, Wagg AS, Huygens SA, Nielen MM, Albers-Heitner CP, Redekop WK, Rutten-van Mölken MP, Al MJ - PLoS ONE (2015)

Bottom Line: The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only.In both of these groups no health gains were achieved.

View Article: PubMed Central - PubMed

Affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.

ABSTRACT

Objective: Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.

Method: A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs.

Results: With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved.

Conclusion: Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

No MeSH data available.


Related in: MedlinePlus

Decision analytic model structure.*M denotes Markov model structure.
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pone.0138225.g001: Decision analytic model structure.*M denotes Markov model structure.

Mentions: To calculate the cost-effectiveness of the implementation of the optimum continence service specification, a decision analytical model was developed using Excel (Fig 1). The aim of the model was to compare the total costs and health benefits of the current standard of care (current care) for UI with an alternative standard of care approach that incorporates the optimum continence service specification (new care). The new approach to care consists of more active detection of patients with UI and the initial assessment and treatment by a nurse continence specialist (NS). The potential improvement in tailoring the prescribed containment products to the patient’s and carer’s needs and the potential improvement in case coordination were not included in the current evaluation, as no studies were retrieved that quantified such effects. The calculations of costs and health benefits were limited to a time horizon of 3 years. The model was also used to perform a 3-year budget impact analysis.


Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

Holtzer-Goor KM, Gaultney JG, van Houten P, Wagg AS, Huygens SA, Nielen MM, Albers-Heitner CP, Redekop WK, Rutten-van Mölken MP, Al MJ - PLoS ONE (2015)

Decision analytic model structure.*M denotes Markov model structure.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591337&req=5

pone.0138225.g001: Decision analytic model structure.*M denotes Markov model structure.
Mentions: To calculate the cost-effectiveness of the implementation of the optimum continence service specification, a decision analytical model was developed using Excel (Fig 1). The aim of the model was to compare the total costs and health benefits of the current standard of care (current care) for UI with an alternative standard of care approach that incorporates the optimum continence service specification (new care). The new approach to care consists of more active detection of patients with UI and the initial assessment and treatment by a nurse continence specialist (NS). The potential improvement in tailoring the prescribed containment products to the patient’s and carer’s needs and the potential improvement in case coordination were not included in the current evaluation, as no studies were retrieved that quantified such effects. The calculations of costs and health benefits were limited to a time horizon of 3 years. The model was also used to perform a 3-year budget impact analysis.

Bottom Line: The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only.In both of these groups no health gains were achieved.

View Article: PubMed Central - PubMed

Affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.

ABSTRACT

Objective: Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.

Method: A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs.

Results: With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved.

Conclusion: Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

No MeSH data available.


Related in: MedlinePlus