Abstract
BackgroundIn an ageing population, it is inevitable to improve the management of care for community-dwelling elderly with incontinence. A previous study showed that implementation of the Optimum Continence Service Specification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseases results in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societal costs. The aim of this study was to explore future consequences of the OCSS strategy of various healthcare policy scenarios in an ageing population.MethodsWe adapted a previously developed decision analytical model in which the OCSS new care strategy was operationalised as the appointment of a continence nurse specialist located within the general practice in The Netherlands. We used a societal perspective including healthcare costs (healthcare providers, treatment costs, insured containment products, insured home care), and societal costs (informal caregiving, containment products paid out-of-pocket, travelling expenses, home care paid out-of-pocket). All outcomes were computed over a three-year time period using two different base years (2014 and 2030). Settings for future policy scenarios were based on desk-research and expert opinion.ResultsOur results show that implementation of the OSCC new care strategy for urinary incontinence would yield large health gains in community dwelling elderly (2030: 2592–2618 QALYs gained) and large cost-savings in The Netherlands (2030: health care perspective: €32.4 Million - €72.5 Million; societal perspective: €182.0 Million - €250.6 Million). Savings can be generated in different categories which depends on healthcare policy. The uncertainty analyses and extreme case scenarios showed the robustness of the results.ConclusionsImplementation of the OCSS new care strategy for urinary incontinence results in an improvement in the quality of life of community-dwelling elderly, a reduction of the costs for payers and affected elderly, and a reduction in time invested by carers. Various realistic policy scenarios even forecast larger health gains and cost-savings in the future. More importantly, the longer the implementation is postponed the larger the savings foregone. The future organisation of healthcare affects the category in which the greatest savings will be generated.
Highlights
In an ageing population, it is inevitable to improve the management of care for community-dwelling elderly with incontinence
We adapted our previously developed decision analytical model [16] to calculate future cost-effectiveness and budgetary consequences of the implementation of the optimum continence service specification (OCSS) for urinary incontinence in the primary care setting in The Netherlands
Operationalisation of the optimum continence service specification (OCSS) The Optimum Continence Service Specification (OCSS) strategy is not yet implemented in The Netherlands. It was operationalised in our model as the appointment of a nurse specialist who is responsible for urinary continence care within the General practitioner (GP) practice in the Dutch primary care setting
Summary
It is inevitable to improve the management of care for community-dwelling elderly with incontinence. A previous study showed that implementation of the Optimum Continence Service Specification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseases results in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societal costs. Urinary incontinence is often considered as a condition inherent to ageing and many affected individuals are unaware of available treatments [2, 3]. As a consequence, it may take a long time before people tend to seek medical advice; more than half of the affected individuals never seek treatment [4, 5]. Urinary incontinence is associated with an increasing risk for falls, fall-related injuries, skin problems, nursing home admissions, and prolonged hospital admissions [7,8,9] and, associated with high societal costs [9,10,11]
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