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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

Markov model structure.
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pone.0138225.g002: Markov model structure.

Mentions: Patients who enter the treatment for cure pathway flow into a Markov process where they will move to one of three possible health states (Fig 2): 1) incontinent; 2) improvement, where patients experience at least 50% fewer incontinence episodes; and 3) success, where patients experience 100% fewer incontinence episodes. All patients begin the first treatment cycle in the incontinent health state. Each cycle in the model lasts 3 months. In the later cycles, patients can move from the incontinent health state to the improvement or success health states. Patients who enter the improvement health state can either remain in the improvement state or move to the success state. Patients who enter the success state remain in the state for the duration of the 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)

Markov model structure.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0138225.g002: Markov model structure.
Mentions: Patients who enter the treatment for cure pathway flow into a Markov process where they will move to one of three possible health states (Fig 2): 1) incontinent; 2) improvement, where patients experience at least 50% fewer incontinence episodes; and 3) success, where patients experience 100% fewer incontinence episodes. All patients begin the first treatment cycle in the incontinent health state. Each cycle in the model lasts 3 months. In the later cycles, patients can move from the incontinent health state to the improvement or success health states. Patients who enter the improvement health state can either remain in the improvement state or move to the success state. Patients who enter the success state remain in the state for the duration of the 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