In a groundbreaking study, researchers have evaluated the cost-effectiveness of Smart Continence Care (SCC) for individuals with profound intellectual and multiple disabilities in the Netherlands. This study, conducted alongside a cluster-randomized trial, aims to assess whether SCC can provide a more efficient and personalized approach to incontinence care compared to traditional methods.
Globally, an estimated 1% to 3% of the population has an intellectual disability, defined by an IQ below 70. In the Netherlands, this figure stands at 2.3%, equating to approximately 400,000 individuals. Among them, around 10,000 people have profound intellectual and multiple disabilities, with 90% residing in long-term care facilities where they receive continuous support.
Challenges in Continence Care
Continence care for these individuals is a significant aspect of their daily support, often managed through fixed schedules rather than on-demand changes. This can lead to inefficiencies, such as unnecessary changes or potential leakages, resulting in increased resource use and potential medical complications like skin irritation.
Technological advancements in care, such as SCC, aim to address these inefficiencies. SCC utilizes sensors within incontinence materials to alert caregivers when a change is necessary, potentially optimizing care and reducing unnecessary interventions.
The Study: Design and Implementation
The economic evaluation was conducted across six Dutch long-term care organizations, involving 156 participants. These organizations were randomly assigned to continue regular continence care (RCC) or implement SCC. The study aimed to determine the cost-effectiveness and cost-utility of SCC from a societal perspective.
Participants were selected based on specific criteria, including a diagnosis of profound intellectual and multiple disabilities and the inability to communicate their needs. The SCC system used, developed by Abena Nova, included integrated sensors and a mobile app to notify caregivers about the saturation levels of incontinence materials.
Implementation and Training
Caregivers received extensive training on using the SCC system, which included a web-based platform displaying voiding patterns and notifications. This training was crucial for adapting their routines to the new technology, which required a shift from fixed schedules to on-demand changes.
Results and Economic Analysis
The study revealed that SCC did not significantly reduce the number of leakages compared to RCC. However, it did lead to a decrease in the number of unnecessary incontinence material changes, suggesting potential benefits in terms of personalized care.
SCC is estimated to have higher total societal costs than RCC, with an increase of €352 over 12 weeks.
Despite the higher costs, the study found no significant improvements in quality of life, as measured by Quality Adjusted Life Years (QALY). The uncertainty surrounding these results highlights the complexity of implementing new technologies in care settings.
Sensitivity and Subgroup Analyses
Further analyses indicated that SCC might become more cost-effective with new pricing models and larger-scale implementations. However, the study emphasized the importance of proper implementation to achieve the potential benefits of SCC.
Implications and Future Directions
This study underscores the challenges and potential of integrating technology into care for individuals with profound disabilities. While SCC offers a promising approach to personalized care, its cost-effectiveness remains uncertain.
The findings suggest that future research should focus on long-term evaluations and developing more suitable instruments for measuring quality of life in this population. Additionally, care organizations may need to consider both societal and provider perspectives when deciding on the implementation of such technologies.
Ultimately, while SCC may not currently offer a cost-effective solution, it presents an opportunity to enhance personalized care through technological innovation. The study’s insights could guide future developments in care technology, aiming for both improved outcomes and economic sustainability.
