title: Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: K M
authors.initials: KM
authors.lastname: Holtzer-Goor
authors.affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Gaultney
authors.affiliation: Zonnehuisgroep Amstelland, Medical department, Amstelveen, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: van Houten
authors.affiliation: University of Alberta, Department of Medicine, Edmonton, AB, Canada.
authors.forename: A S
authors.initials: AS
authors.lastname: Wagg
authors.affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Huygens
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), Department of General Practice, Utrecht, the Netherlands.
authors.forename: M M J
authors.initials: MM
authors.lastname: Nielen
authors.affiliation: Maastricht University Medical Center, Department of Obstetrics and Gynecology, Maastricht, the Netherlands.
authors.forename: C P
authors.initials: CP
authors.lastname: Albers-Heitner
authors.affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: W K
authors.initials: WK
authors.lastname: Redekop
authors.affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: Rutten-van Mölken
authors.affiliation: Erasmus University Rotterdam, Institute for Medical Technology Assessment / Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Al
mesh_terms: D000368:Aged; D002017:Budgets; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D009720:Nurse Clinicians / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D014549:Urinary Incontinence / Q000191:economics / Q000451:nursing* / Q000628:therapy*