Uncertainty analyses the impact of each input

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Uncertainty analyses The impact of each input parameter of the model on the incremental costs (per person) was assessed using one-way sensitivity analysis. The tornado diagram (see Fig. 2 ) shows the ten most influential parameters in sce- nario 1 (2030). This scenario presents an extrapolation to 2030 of the current situation (2014). In that sense, it represents the base case scenario for future predictions. The ranges of incremental costs are always negative, thus result in lower costs except when the percentage of incidence cases treated for containment only in the new care strategy is increased from 61 to 85%. In this case, the new care strategy could be slightly more costly ( 7.87 per patient in 3 years). We observed that parame- ters associated with the effectiveness of the new care strategy are the most influential on the incremental costs. In particular, we observed that increasing the per- centage of incidence cases treated for containment only, the detection rate of urinary incontinence by the nurse specialist, or the success rate of the new care strategy re- sulted in decreasing costs. Other influential parameters on the incremental costs are associated with the costs of formal home care (unit costs per hour, number of hours provided per week, and reduction of hours in success cases), the frequency of use of formal and informal care in patients treated with usual care, and the out-of- Table 4 Budgetary impact of implementing the OCSS new care strategy over a period of 3 years Current situation (2014) Scenario 1 (2030) Scenario 2 (2030) Scenario 3 (2030) Scenario 4 (2030) Total number of patient-years a 914,598 1,512,157 1,512,157 1,512,157 1,526,030 Healthcare perspective - 30.709 M - 50.816 M - 32.410 M - 32.410 M - 72.481 M Societal perspective - 124.659 M - 206.160 M - 224.231 M - 182.031 M - 250.637 M M million a Total of number of patient-years in the three-year time period (including an annual inflow and outflow) Fig. 1 Breakdown of the 3-year budgetary impact Franken et al. BMC Family Practice (2018) 19:31 Page 7 of 11
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pocket expenditures for containment products incurred by patients managing urinary incontinence with self-care. The tornado diagrams (not shown) from the other scenarios are similar to scenario 1 (Fig. 2 ). In fact, the same 10 parameters are most important, but from rank 7 onwards some of the parameters change position. The results of the propobabilistic sensitivity analysis (PSA; all parameters varied at the same time) are similar for all scenarios. The new care strategy is, on average per per- son, more effective and less costly compared to usual care. The gain in QALYs ranges from 0.0045 (current situation and scenario 2) to 0.0048 (scenario 1). The incremental cost savings range from 315 (scenario 3) to 430 (scenario 4). Table 5 also shows the PSA estimates for the probability that the new care strategy is i) more effective, ii) less costly, iii) dominant (i.e., more effective and less costly), and iv) cost-effective at a threshold of 20,000. The least favorable setting for the new care strategy is the one considered in scenario 2 (estimated probabilities: 93.0, 92.3, 91.4, and 92.4%, respectively). Table 5
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