In a groundbreaking study conducted across the Netherlands, researchers have evaluated the economic viability of Smart Continence Care (SCC) for individuals with profound intellectual and multiple disabilities. This study, conducted alongside a cluster-randomized trial, seeks to determine whether SCC offers a cost-effective alternative to regular continence care (RCC) within residential care facilities.
With an estimated 2.3% of the Dutch population having an IQ below 70, the need for specialized care is significant. Among these individuals, approximately 10,000 have profound intellectual and multiple disabilities, with 90% residing in long-term care facilities. The study aims to assess whether SCC can enhance care efficiency and reduce costs, given the substantial portion of the Dutch long-term care budget allocated to disability care.
Understanding the Need for Smart Continence Care
The traditional approach to continence care involves changing incontinence materials (IM) at fixed intervals, which can lead to inefficiencies. Changing too early wastes resources, while changing too late can cause discomfort and medical complications. SCC, which uses sensor-equipped IM to notify caregivers when a change is necessary, promises to address these issues by optimizing the timing of changes.
With the increasing demand for healthcare services and a declining number of caregivers, technologies like SCC could play a crucial role in sustaining the healthcare system. By providing timely notifications, SCC aims to improve the quality of care and reduce unnecessary workload for caregivers.
Study Design and Methodology
The economic evaluation was conducted alongside a cluster-randomized trial across six Dutch care organizations. A total of 165 participants were enrolled, with 156 included in the intention-to-treat analyses. Participants were randomly assigned to either the SCC group or the RCC group, with the former receiving sensor-equipped IM and training on the new technology.
Data collection spanned from September 2021 to April 2023, with measurements taken at baseline, six weeks, and twelve weeks. The study adhered to Dutch guidelines for economic evaluations in healthcare, ensuring rigorous and standardized analysis.
Participants and Recruitment
Participants were selected based on specific criteria, including a diagnosis of profound intellectual and multiple disabilities and the use of incontinence products. Exclusion criteria included the use of a permanent catheter or behaviors that could interfere with the technology, such as a pica disorder.
The study involved 29 locations across the Netherlands, with care provided by different teams throughout the day. This setup allowed for a comprehensive evaluation of SCC’s impact across various care settings.
Results and Implications
The study found that SCC did not significantly reduce the number of leakages compared to RCC. However, it did reduce the number of unnecessary IM changes, suggesting potential benefits in terms of resource use and personal convenience.
SCC is estimated to have higher total societal costs than RCC, with an estimated increase of €352 over 12 weeks.
Despite the higher costs, SCC showed promise in reducing the frequency of IM changes, which could lead to fewer disruptions in the daily lives of individuals with profound disabilities. However, this did not translate into significant time savings for caregivers.
Quality of Life and Cost-Utility Analysis
The study also evaluated the impact of SCC on quality of life using the EQ-5D-5L instrument. The results indicated no significant improvement in quality of life, highlighting the challenges of measuring such outcomes in this population.
From a cost-utility perspective, the results were inconclusive, with substantial uncertainty around the quality of life improvements. The probability of SCC being cost-effective was estimated to be between 0 and 0.5 at a willingness-to-pay threshold of €50,000 per quality-adjusted life year (QALY).
Challenges and Future Directions
The study underscores the complexity of implementing SCC in residential care settings. Factors such as staff turnover and implementation challenges can significantly impact the effectiveness of new technologies.
Future research should focus on developing more suitable instruments for measuring quality of life in individuals with profound intellectual and multiple disabilities. Additionally, longer-term studies are needed to assess the potential time savings and overall impact of SCC on care efficiency.
While the current study highlights the potential of SCC to improve continence care, it also emphasizes the need for careful consideration of implementation strategies and the development of appropriate evaluation tools. As healthcare systems continue to evolve, technologies like SCC could play a vital role in enhancing care quality and sustainability.
