1 research outputs found
Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.
#### 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. Furth