Demographic changes in an ageing population the

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demographic changes in an ageing population, the number of elderly affected with urinary incontinence will rise in the future [ 17 ]. Our future scenarios (in 2030) reveal that these changes only further necessity an appropriate strategy to manage the increasing needs of elderly living in the com- munity. Although we cannot foretell future healthcare pol- icies, our results illustrate that various realistic policy scenarios (defined by experts) lead to large health gains and cost-savings by implementing the OSCC new care strategy for urinary incontinence in 2030 (QALYs: 2592 2618; costs health care perspective: 32.4 - 72.5 Million; costs societal perspective: 182.0 250.6 Million). The different scenarios clearly explicate where the greatest cost-savings can be generated (i.e., healthcare payer, society, or the affected elderly and his/her family). We estimated that there is a high probability (> 92% in all our scenarios) that the OCSS new care strategy is more effect- ive and less costly, irrespectively of healthcare setting. Even in extreme case scenarios our results appeared to be rather robust and the implementation of the OCSS new care strategy remained cost-saving compared to usual care. Several studies [ 12 14 ] indicated areas for improvement in the management and treatment of urinary incontin- ence. Our results show that improvement of care path- ways by implementing a continence nurse specialist not only results in better clinical outcomes but also contrib- utes to important cost-savings. It should be noted that our study only investigated consequences in the community setting. Therefore, some of the savings and/or expendi- tures in care for community-dwelling elderly with urinary incontinence may be at the cost of spending and/or saving money in urinary incontinence affected elderly in non- community settings. For example, the population in the fourth scenario is slightly different from the first three scenarios (i.e., greater number of patient life-years over a 3-year time period due to a lower rate of institutionalisa- tion [1,526,030 vs. 1,512,157]). Therefore, the results on the budgetary impact between the scenarios need careful interpretation. The effectiveness estimates of care provided by a nurse specialist in our study are based on an RCT by Subak et al. [ 18 ] and on the awareness study [ 19 ]. Other studies re- ported conflicting outcomes regarding the effectiveness and costs of a nurse specialist. These studies are, however, not entirely comparable to our study. Moore et al. [ 25 ] re- ported no differences in health outcomes between conser- vative treatment provided by continence nurse advisors and urogynaecologists in the United Kingdom (UK). A more recent study in the UK by Williams et al. [ 26 ] showed better health outcomes due to the new nurse led service but at higher costs. In contrast to our study, Williams et al.
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