JMIR Publications

ABSTRACT

Background:

People with profound intellectual and multiple disabilities (PIMD) in residential care facilities may benefit from smart continence care (SCC), which is incontinence material (IM) with integrated sensors that notify caregivers when the IM is saturated and requires changing. SCC aims to reduce weekly leakages and improve quality of life.

Objective:

Given the growing demand for healthcare services and the decreasing workforce, it is essential to assess the cost-effectiveness and cost-utility of such technologies.

Methods:

This economic evaluation is conducted alongside a cluster randomized trial across six care organizations in the Netherlands. The incremental cost-effectiveness ratio (ICER) was expressed as additional societal costs of SCC in relation to a reduction in weekly leakages. The incremental cost-utility ratio (ICUR) used QALYs measured via EQ-5D-5L proxy 1. Robustness was assessed using bootstrapping, sensitivity, subgroup and scenario analyses for variations in pricing and alternative outcomes (weekly incontinence material changes (IMCs) and time savings). The study period was 12 weeks.

Results:

The analyses included 74 participants in the regular continence care (RCC) group and 82 participants in the SCC group. Analyses were corrected for baseline differences in the time spent on continence care and utility. SCC is found to be less effective (-1.058 with 95% CI -1.878 to -0.262) and more costly (US $ 371 with 95% CI US $-0.09 to US $771) than RCC for number of leakages as the outcome, placing the ICER in the northwest (inferior) quadrant of the cost-effectiveness plane. Cost-utility analyses showed a high uncertainty, with results in both the northwest and northeast quadrants. Subgroup analyses suggest that the negative effect on leakages was due to implementation challenges. Sensitivity analyses showed that the new pricing model of the supplier had a slight positive effect and lowered the estimated total societal costs although uncertainty remains. SCC was estimated to effectively reduce weekly IMCs (ICER in the northeast quadrant) but did not save time (ICER in the northwest quadrant).

Conclusions:

The results of this economic evaluation are not conclusive, because of the mixed outcomes and a limited timeframe. SCC is ineffective in reducing the number of weekly leakages but does reduce the number of weekly IM changes. However, time spent on continence care did not show a reduction as a consequence of SCC. Findings suggest that SCC is expected to be more expensive than RCC, although the supplier's new pricing model may decrease costs. The use of technologies such as SCC should not solely be based on cost-effectiveness and cost-utility outcomes. This technology offers value by generating data that can support personalized care. However, the realization of this added value is not guaranteed and may differ between individuals. Implementation challenges and individual variability underline the need for tailored approaches. Clinical Trial: ClinicalTrials.gov NCT05481840 (https://clinicaltrials.gov/ct2/show/NCT05481840)