经皮胫神经电刺激（TTNS）治疗养老院居民尿失禁的成本后果分析，同时进行随机对照试验。
Cost consequence analysis of transcutaneous tibial nerve stimulation (TTNS) for urinary incontinence in care home residents alongside a randomised controlled trial.
机构信息
Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, G4 0BA, UK.
NMAHP Research Unit, University of Stirling, Stirling, FK9 4LA, UK.
出版信息
BMC Geriatr. 2023 Nov 22;23(1):766. doi: 10.1186/s12877-023-04459-z.
BACKGROUND
Urinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation.
METHODS
A cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads.
RESULTS
HRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period).
CONCLUSIONS
Use of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.
TRIAL REGISTRATION
ISRCTN98415244, registered 25/04/2018. NCT03248362 (Clinical trial.gov number), registered 14/08//2017.
背景
尿失禁（UI）在超过一半的护理和养老院居民中较为普遍，会对尊严和生活质量产生不利影响。养老院主要使用吸收垫来控制 UI，而不是积极治疗这种情况。经皮 tibial 神经刺激（TTNS）是一种非侵入性、安全、低成本的干预措施，已被证明可有效减少成年人的 UI。我们研究了为养老院居民提供 TTNS 与假（非活动）电刺激相比的成本和后果。
方法
采用成本后果分析方法，对 ELECTRIC 试验的资源使用和结果数据进行了汇总和呈现，该试验将来自英国 37 家养老院的 406 名 UI 居民随机分为接受 TTNS 或假（非活动）TTNS 治疗的 12 个疗程，每个疗程 30 分钟。TTNS 由养老院工作人员在 6 周内进行管理。使用 DEMQOL-U 和 DEMQOL-PROXY-U 在基线、6 周和 18 周随访时测量健康状态效用。工作人员在基线、6 周和 18 周随访时完成了一份资源使用问卷，该问卷还评估了吸收垫的使用情况。
结果
两组随机患者的 HRQoL 均无显著变化。TTNS 的治疗费用估计为每位参与者 81.20 英镑，每位工作人员的培训和支持费用为 121.03 英镑。85%的参与者需要日常的厕所援助，平均需要一名或两名工作人员在每次 24 小时内参与 4 到 5 次。报告了每天使用移动辅助工具和其他辅助设备上厕所的情况。为帮助居民使用厕所而花费的工作人员时间的价值（假设每位居民每次访问平均需要 5 分钟）估计为 TTNS 为 19.17 英镑（SD 13.22），假（SD 13.33）为 17.30 英镑（每位居民在 24 小时内）。
结论
使用 TTNS 治疗养老院居民的 UI 并未导致资源使用的变化，特别是没有减少吸收垫的使用，也没有显示 TTNS 的成本效益。在养老院管理控尿是一项劳动密集型工作，需要大量的工作人员时间和设备辅助。
试验注册
ISRCTN84916035，注册于 2018 年 4 月 25 日。NCT03248362（临床试验.gov 编号），于 2017 年 8 月 14 日注册。
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