title: Cost-effectiveness of involving nurse specialists for adult patients with urinary incontinence in primary care compared to care-as-usual: an economic evaluation alongside a pragmatic randomized controlled trial.
abstract: OBJECTIVE
  To determine the 12-month, societal cost-effectiveness of involving urinary incontinence (UI) nurse specialists in primary care compared to care-as-usual by general practitioners (GPs).
  
  
  METHODS
  From 2005 until 2008 an economic evaluation was performed alongside a pragmatic multicenter randomized controlled trial comparing UI patients receiving care by nurse specialists with patients receiving care-as-usual by GPs in the Netherlands. One hundred eighty-six adult patients with stress, urgency, or mixed UI were randomly allocated to the intervention and 198 to care-as-usual; they were followed for 1 year. Main outcome measures were Quality Adjusted Life Year (QALY(societal) ) based on societal preferences for health outcomes (EuroQol-5D), QALY(patient) based on patient preferences for health outcomes (EuroQol VAS), and Incontinence Severity weighted Life Year (ISLY) based on patient-reported severity and impact of UI (ICIQ-UI SF). Health care resource use, patient and family costs, and productivity costs were assessed. Data were collected by three monthly questionnaires. Incremental cost-effectiveness ratios were calculated. Uncertainty was assessed using bootstrap simulation, and the expected value of perfect information was calculated (EVPI).
  
  
  RESULTS
  Compared to care-as-usual, nurse specialist involvement costs € 16,742/QALY(societal) gained. Both QALY(patient) and ISLY yield slightly more favorable cost-effectiveness results. At a threshold of € 40,000/QALY(societal,) the probability that the intervention is cost-effective is 58%. The EVPI amounts to € 78 million.
  
  
  CONCLUSIONS
  Based on these results, we recommend adopting the nurse specialist intervention in primary care, while conducting more research through careful monitoring of the effectiveness and costs of the intervention in routine practice.
authors.affiliation: Department of Integrated Care, Maastricht University Medical Centre, Maastricht, the Netherlands. c.albers@maastrichtuniversity.nl
authors.forename: C P
authors.initials: CP
authors.lastname: Albers-Heitner
authors.forename: M A
authors.initials: MA
authors.lastname: Joore
authors.forename: R A G
authors.initials: RA
authors.lastname: Winkens
authors.forename: A L M
authors.initials: AL
authors.lastname: Lagro-Janssen
authors.forename: J L
authors.initials: JL
authors.lastname: Severens
authors.forename: L C M
authors.initials: LC
authors.lastname: Berghmans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000191:economics / Q000451:nursing*