Smart Continence Care for People With Profound Intellectual and Multiple Disabilities Within Dutch Residential Care Facilities: Economic Evaluation Alongside a Cluster Randomized Trial

Background: Persons with profound intellectual and multiple disabilities 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 the quality of life. Objective: Given the growing demand for health care services and the decreasing workforce, it is essential to assess the cost-effectiveness and cost-utility of such technologies. Methods: This economic evaluation was conducted alongside a cluster randomized trial across 6 care organizations in the Netherlands. The incremental cost-effectiveness ratio (ICER) was expressed as the additional societal costs of SCC in relation to a reduction in weekly leakages. The incremental cost-utility ratio used Quality Adjusted Life Years measured via the EQ-5D-5L proxy 1 version. Robustness was assessed using bootstrapping, sensitivity, and subgroup analyses for variations in pricing and alternative outcomes (weekly IM 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, 95% CI –1.878 to –0.262) and more costly (US $371, 95% CI US$ –0.09 to $771) than RCC for the number of leakages as the outcome, placing the ICER in the northwest (NW; inferior) quadrant of the cost-effectiveness plane. Cost-utility analyses showed a high uncertainty, with results in both the NW and northeast quadrants. Scenario analysis suggested that the negative effect on leakages was due to implementation challenges. Sensitivity analyses showed that the supplier’s new pricing model had a slight positive effect, reducing 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 NW 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 it does reduce the number of weekly IMCs. However, SCC was not effective in reducing time spent on continence care. 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.