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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

Diagram depicting the impact of influential parameters on the cost-savings.
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pone.0138225.g004: Diagram depicting the impact of influential parameters on the cost-savings.

Mentions: Results from the OWSA are presented in Fig 4, showing the impact of influential parameters on the estimate for incremental costs. While the range of incremental costs consistently fall below zero, i.e., cost-saving, the magnitude of cost-savings is influenced by a number of parameters. The most influential parameters include estimates associated with the effectiveness of new care. Cost-savings are increased as the percentage of patients receiving treatment for cure by the NS increases, the detection rate of UI patients attributable to the NS increases, and the success rate of NS care increases. Other influential factors include the costs and frequency of use of both formal and informal care in current care and the out-of-pocket costs of containment products for patients who manage their incontinence with self-care. The influence of direct costs outside the health care sector underscores the need to consider the societal costs when performing economic evaluations of UI care.


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)

Diagram depicting the impact of influential parameters on the cost-savings.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0138225.g004: Diagram depicting the impact of influential parameters on the cost-savings.
Mentions: Results from the OWSA are presented in Fig 4, showing the impact of influential parameters on the estimate for incremental costs. While the range of incremental costs consistently fall below zero, i.e., cost-saving, the magnitude of cost-savings is influenced by a number of parameters. The most influential parameters include estimates associated with the effectiveness of new care. Cost-savings are increased as the percentage of patients receiving treatment for cure by the NS increases, the detection rate of UI patients attributable to the NS increases, and the success rate of NS care increases. Other influential factors include the costs and frequency of use of both formal and informal care in current care and the out-of-pocket costs of containment products for patients who manage their incontinence with self-care. The influence of direct costs outside the health care sector underscores the need to consider the societal costs when performing economic evaluations of UI care.

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