Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
PLoS One. 2024 Jan 2;19(1):e0295846. doi: 10.1371/journal.pone.0295846. eCollection 2024.
The aim of this study was first, to introduce a comprehensive, de-novo health economic (HE) model incorporating the full range of activities involved in toileting and containment care (T&CC) for people with incontinence, capturing all the potential benefits and costs of existing and future Digital Health Technologies (DHT) aimed at improving continence care, for both residential care and home care. Second, to use this novel model to evaluate the cost-effectiveness of the DHT TENA SmartCare Identifi in the implementation of person-centred continence care (PCCC), compared with conventional continence care for Canadian nursing home residents. The de-novo HE model was designed to evaluate technologies across different care settings from the perspective of several stakeholders. Health states were based on six care need profiles with increasing need for toileting assistance, three care stages with varying degrees of toileting success, and five levels of skin health. The main outcomes were incremental costs and quality-adjusted life years. The effectiveness of the TENA SmartCare Identifi was based primarily on trial data combined with literature and expert opinion where necessary. Costs were reported in CAD 2020. After 2 years, 21% of residents in the DHT group received mainly toileting as their continence care strategy compared with 12% in the conventional care group. Conversely, with the DHT 15% of residents rely mainly on absorbent products for incontinence care, compared with 40% with conventional care. On average, residents lived for 2.34 years, during which the DHT resulted in a small gain in quality-adjusted life years of 0.015 and overall cost-savings of $1,467 per resident compared with conventional care. Most cost-savings were achieved through reduced costs for absorbent products. Since most, if not all, stakeholders gain from use of the DHT-assisted PCCC, widespread use in Canadian residential care facilities should be considered, and similar assessments for other countries encouraged.
这项研究的目的首先是引入一个综合的、全新的卫生经济学(HE)模型,该模型纳入了与失禁患者的如厕和失禁护理(T&CC)相关的所有活动,涵盖了旨在改善失禁护理的现有和未来数字健康技术(DHT)的所有潜在效益和成本,无论是在住院护理还是家庭护理中。其次,利用这个新模型评估 DHT TENA SmartCare Identifi 在实施以人为主导的失禁护理(PCCC)方面的成本效益,与加拿大养老院居民的常规失禁护理相比。全新的卫生经济学模型旨在从多个利益相关者的角度评估不同护理环境中的技术。健康状况基于六种护理需求概况,这些概况的护理需求随如厕辅助程度的增加而增加,有三个不同程度的如厕成功护理阶段,以及五种皮肤健康水平。主要结果是增量成本和质量调整生命年。TENA SmartCare Identifi 的有效性主要基于试验数据,必要时结合文献和专家意见。成本以 2020 年加元报告。两年后,与常规护理组的 12%相比,DHT 组的 21%居民主要采用如厕策略作为其失禁护理策略。相反,在 DHT 组中,有 15%的居民主要依靠吸收性产品来护理失禁,而常规护理组则有 40%。平均而言,居民的预期寿命为 2.34 年,在这段时间内,与常规护理相比,DHT 使质量调整生命年增加了 0.015 年,每位居民的总成本节省了 1467 加元。大部分成本节省来自吸收性产品成本的降低。由于如果不是所有的利益相关者,那么大多数利益相关者都能从 DHT 辅助的 PCCC 中受益,因此应考虑在加拿大的住院护理机构中广泛使用,并鼓励其他国家进行类似的评估。