Overview: Why Smart Continence Care Matters for Profound Disabilities
In the Netherlands, about 10,000 people live with profound intellectual and multiple disabilities (PIMD), with roughly 9,000 spending most of their lives in residential care. Personal hygiene needs, especially continence care, consume substantial resources. Traditional continence care (TCC) relies on fixed schedules rather than changing needs. Smart continence care (SCC)—which uses sensors in incontinence material (IM) and a responsive notification system for caregivers—promises more personalized care, potential improvements in quality of life, and time savings for care staff. A recent cluster randomized trial (CRT) across six Dutch care organizations evaluated the clinical and economic value of SCC against regular continence care (RCC). This article summarizes the key questions, methods, and outcomes from the accompanying economic evaluation.
What Was Studied?
The study compared SCC with RCC from a societal perspective over a 12-week period. It examined whether sensor-equipped IMs reduce weekly leakages, the need for changes in IMCs (on-demand changes), and the broader impact on caregiver time, healthcare utilization, and quality-adjusted life years (QALYs). The trial included 156 participants with PIMD who used incontinence products and could not communicate changes in their needs directly. Data collection occurred at baseline, 6 weeks, and 12 weeks, following Dutch guidelines for economic evaluations in healthcare (CHEERS) and related standards.
How Was the Economic Evidence Gathered?
Costs were identified and valued from three perspectives: societal, care organization, and participant/family. Societal costs included care staff time, IMs and disposables, wound and skin care, laundry, and the SCC system (hardware and licensing). Other health care costs were captured via proxy reporting on general practitioner and specialty visits, aligned with the iMCQ instrument. Travel costs for families were also included. Importantly, 12-week costs did not amortize startup or longer-term investments.
Effectiveness was measured by changes in weekly leakages and, separately, by QALYs calculated with proxy-rated EQ-5D-5L scores completed by professional caregivers. Although the EQ-5D-5L is standard in Dutch evaluations, its suitability for people with PIMD is debated due to conceptual limitations in reflecting quality of life for this group.
Key Findings: Costs, Effectiveness, and Uncertainty
The base-case analysis suggested that SCC incurred higher total societal costs than RCC over 12 weeks, largely driven by caregiver time. Specifically, SCC had about €352 higher total societal costs than RCC, with wide confidence intervals. In terms of effectiveness, SCC did not reduce weekly leakages compared with RCC; in fact, the adjusted results indicated a small, non-significant increase in leakages under SCC. The base-case cost-utility analysis showed substantial uncertainty around any QALY gains, with the probability of SCC being cost-effective at common willingness-to-pay (WTP) thresholds hovering around 0-40% depending on the threshold (e.g., €50,000 per QALY).
When outcomes focused on IMCs—the number of times incontinence material needed changing—the picture brightened for SCC. Sensitivity analyses consistently showed reductions in weekly IMCs with SCC, suggesting potential benefits in reducing unnecessary IMC changes and disruptions to daily life for residents. These gains did not translate into clear time savings for care staff within the 12-week window, which may reflect transitional implementation challenges rather than intrinsic inefficacy of SCC.
Implications for Policy and Practice
From a policy perspective, SCC’s value appears nuanced. The technology may not reliably lower overall costs or improve measured QALYs within a 12-week horizon, especially when startup costs and longer-term maintenance are excluded. However, SCC’s potential to reduce unnecessary IMCs could offer user-centered advantages, less disruption to residents, and better data for personalized care planning. The economics improve under new pricing models that reduce per-user licensing and bundle training/support differently, suggesting that cost-effectiveness may depend on scale and procurement terms.
Strengths, Limitations, and Future Research
Strengths include the CRT design, robust data handling with multiple imputation and bootstrapping, and alignment with Dutch economic evaluation guidelines. Limitations include the short 12-week horizon, incomplete medication cost capture, and questions about the EQ-5D-5L’s validity for this population. The authors emphasize the need for a disease-specific quality-of-life instrument for people with PIMD and longer follow-up to assess whether benefits in IMC reduction can translate into tangible time savings and improved resident well-being over time.
Bottom Line
Smart continence care offers promise for people with profound disabilities and their caregivers, but current evidence from a societal perspective indicates higher costs with uncertain QALY gains and no clear reduction in leakages over 12 weeks. The potential for reduced IMC changes is a compelling signal, yet more research—over longer periods with refined QoL measures and tailored implementation strategies—is needed before SCC can be deemed clearly cost-effective. Decision-makers should consider scalable procurement approaches and realistic implementation timelines to unlock potential value while ensuring high-quality, person-centered continence care.
