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
Aims: 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. Neurourol. Urodynam. 31:526–534, 2012. © 2012 Wiley Periodicals, Inc.
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Nineteen studies were ex-post economic evaluations; of those, 17 were cost-effectiveness analyses.
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- Authors
- Albers‐Heitner, C. P., Joore, M. A., Winkens, R. A. G., Lagro‐Janssen, A. L. M., Severens, J. L., & Berghmans, L. C. M.
- Affiliations
- Maastricht University Medical Centre (NL)
- Radboud University Medical Center (NL)
- Erasmus University Rotterdam (NL)
- Corresponding author
- Albers‐Heitner, C.P.
- Venue
- Neurourology and Urodynamics
- Publisher
- Wiley
- Published
- 2012-01-24
- Volume
- 31
- Issue
- 4
- Pages
- 526-534
- ISSN
- 0733-2467 (ISSN-L)
- 1520-6777
- OpenAlex
- W2132421306
- Cited by
- 33
- References
- 20
- Citations by year
- 2026: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 1 · 2019: 3 · 2018: 1 · 2017: 6 · 2016: 4 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 1
- FWCI
- 2.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurourology and Urodynamics (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Keywords
- urinary incontinence, specialist nurses, cost-effectiveness, primary care, general practitioners, stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, quality-adjusted life years, health care utilization, productivity costs, expected value of perfect information
- MeSH terms
- Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Nurse Clinicians, Primary Health Care, Quality of Life, Surveys and Questionnaires, Urinary Incontinence, Treatment Outcome, Health Care Costs, Quality-Adjusted Life Years
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