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

<div><p>Objective</p><p>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.</p><p>Method</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusion</p><p>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.</p></div

Budget impact over a period of 3 years.

<p>M = Million</p><p>Budget impact over a period of 3 years.</p

Input parameters used to model patient flow and treatment effectiveness.

<p>GP: general practitioner, NS: continence nurse specialist, PPT: pelvic physiotherapist, PFMT: pelvic floor muscle training.</p><p>*Costs were valued based on the average daily dose of the following drugs used to treated urge UI: tolterodine, solifenacin, darifenacin, fesoterodine.</p><p>**Costs were valued based on average % of patients 'absolutely dry' after use of tolterodine IR, tolterodine ER, solifenacin, darifenacin, or fesoterodine.</p><p>***Costs were valued based on the average discontinuation rate from the studies that reported results at 9–12 months for the medications: tolterodine, solifenacin, darifenacin, fesoterodine.</p><p>Input parameters used to model patient flow and treatment effectiveness.</p

Cost and utility parameters included in the model.

<p>GP: general practitioner, PPT: pelvic physiotherapist, NS: continence nurse specialist, UTI: urinary tract infections.</p><p>Cost and utility parameters included in the model.</p

Markov model structure.

<p>Markov model structure.</p

Diagram depicting the impact of influential parameters on the cost-savings.

<p>Diagram depicting the impact of influential parameters on the cost-savings.</p

Care pathway for treatment for cure plus containment.

<p>Care pathway for treatment for cure plus containment.</p

Decision analytic model structure.

<p>*M denotes Markov model structure.</p

Outcomes, percentages successfully treated and improved patients.

<p>Outcomes, percentages successfully treated and improved patients.</p

Characteristics of the target patient population.

<p>Characteristics of the target patient population.</p