The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios

Background:In an ageing population, it is inevitable to improve the management of care for community-dwellingelderly with incontinence. A previous study showed that implementation of the Optimum Continence ServiceSpecification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseasesresults in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societalcosts. The aim of this study was to explore future consequences of the OCSS strategy of various healthcare policyscenarios in an ageing population.Methods:We adapted a previously developed decision analytical model in which the OCSS new care strategy wasoperationalised as the appointment of a continence nurse specialist located within the general practice in TheNetherlands. We used a societal perspective including healthcare costs (healthcare providers, treatment costs, insuredcontainment products, insured home care), and societalcosts (informal caregiving, containment products paidout-of-pocket, travelling expenses, home care paid out-of-pocket). All outcomes were computed over athree-year time period using two different base years(2014 and 2030). Settings for future policy scenarioswere based on desk-research and expert opinion.Results:Our results show that implementation of the OSCC new care strategy for urinary incontinence wouldyield large health gains in community dwelling elderly (2030: 2592–2618 QALYs gained) and large cost-savings in TheNetherlands (2030: health care perspective:€32.4 Million -€72.5 Million; societal perspective:€182.0 Million -€250.6Million). Savings can be generated in different categories which depends on healthcare policy. The uncertainty analysesand extreme case scenarios showed the robustness of the results.Conclusions:Implementation of the OCSS new care strategy for urinary incontinence results in an improvement in thequality of life of community-dwelling elderly, a reduction of the costs for payers and affected elderly, and a reductionin time invested by carers. Various realistic policy scenarios even forecast larger health gains and cost-savings in thefuture. More importantly, the longer the implementation is postponed the larger the savings foregone. The futureorganisation of healthcare affects the category in which the greatest savings will be generated