Cost Consequence Analysis of Transcutaneous Tibial Nerve Stimulation (TTNS) for Urinary Incontinence in Care Home Residents alongside a Randomised Controlled Trial

Linda Fenocchi; Helen Mason; Lisa Macaulay; Catriona O’Dolan; Shaun Treweek; Joanne Booth

doi:10.1186/s12877-023-04459-z

Cost Consequence Analysis of Transcutaneous Tibial Nerve Stimulation (TTNS) for Urinary Incontinence in Care Home Residents alongside a Randomised Controlled Trial

Linda Fenocchi^* (Corresponding Author)
, Helen Mason
, Lisa Macaulay
, Catriona O’Dolan
, Shaun Treweek
, Joanne Booth

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

6 Downloads (Pure)

Abstract

Background
Urinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation.

Methods
A cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads.

Results
HRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period).

Conclusions
Use of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.

Original language	English
Article number	766
Number of pages	9
Journal	BMC Geriatrics
Volume	23
Issue number	1
Early online date	22 Nov 2023
DOIs	https://doi.org/10.1186/s12877-023-04459-z
Publication status	Published - 22 Nov 2023

Bibliographical note

Acknowledgements
The authors would like to thank the participants, families and care home staff who took part in the ELECTRIC study. The Health Services Research Unit, University of Aberdeen, is core funded by the Chief Scientist Office of the Scottish Government Health Directorates.

Funding
The ELECTRIC trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme, project number HTA15/130/73. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

economic evaluation
Cost consequence analysisi
Care homes
Urinary incontinence
tibial nerve stimulation

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Cite this

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title = "Cost Consequence Analysis of Transcutaneous Tibial Nerve Stimulation (TTNS) for Urinary Incontinence in Care Home Residents alongside a Randomised Controlled Trial",

abstract = "Background Urinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation. Methods A cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads. Results HRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85\% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period). Conclusions Use of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.",

keywords = "economic evaluation, Cost consequence analysisi, Care homes, Urinary incontinence, tibial nerve stimulation",

author = "Linda Fenocchi and Helen Mason and Lisa Macaulay and Catriona O{\textquoteright}Dolan and Shaun Treweek and Joanne Booth",

note = "Acknowledgements The authors would like to thank the participants, families and care home staff who took part in the ELECTRIC study. The Health Services Research Unit, University of Aberdeen, is core funded by the Chief Scientist Office of the Scottish Government Health Directorates. Funding The ELECTRIC trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme, project number HTA15/130/73. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.",

year = "2023",

month = nov,

day = "22",

doi = "10.1186/s12877-023-04459-z",

language = "English",

volume = "23",

journal = "BMC Geriatrics",

issn = "1471-2318",

publisher = "BioMed Central",

number = "1",

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T1 - Cost Consequence Analysis of Transcutaneous Tibial Nerve Stimulation (TTNS) for Urinary Incontinence in Care Home Residents alongside a Randomised Controlled Trial

AU - Fenocchi, Linda

AU - Mason, Helen

AU - Macaulay, Lisa

AU - O’Dolan, Catriona

AU - Treweek, Shaun

AU - Booth, Joanne

N1 - Acknowledgements The authors would like to thank the participants, families and care home staff who took part in the ELECTRIC study. The Health Services Research Unit, University of Aberdeen, is core funded by the Chief Scientist Office of the Scottish Government Health Directorates. Funding The ELECTRIC trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme, project number HTA15/130/73. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

PY - 2023/11/22

Y1 - 2023/11/22

N2 - Background Urinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation. Methods A cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads. Results HRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period). Conclusions Use of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.

AB - Background Urinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation. Methods A cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads. Results HRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period). Conclusions Use of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.

KW - economic evaluation

KW - Cost consequence analysisi

KW - Care homes

KW - Urinary incontinence

KW - tibial nerve stimulation

U2 - 10.1186/s12877-023-04459-z

DO - 10.1186/s12877-023-04459-z

M3 - Article

C2 - 37993786

SN - 1471-2318

VL - 23

JO - BMC Geriatrics

JF - BMC Geriatrics

IS - 1

M1 - 766

ER -

Cost Consequence Analysis of Transcutaneous Tibial Nerve Stimulation (TTNS) for Urinary Incontinence in Care Home Residents alongside a Randomised Controlled Trial

Abstract

Bibliographical note

UN SDGs

Keywords

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