A health economic analysis of ‘A novel implementation of best evidence practice for incontinence-associated dermatitis’ (IMBED)

Aim: To assess resource usage and other outcomes of implementing a bundle of evidence-based, clinician-led incontinence-associated dermatitis interventions, ‘IMBED’ intervention. 

Methods: Patients with incontinence recruited from 6 public hospitals in Australia in pre-intervention (1 February-31 March 2020) and post-intervention periods (1 May-30 June 2021). For the health economic study, nurses/research officers recorded resource usage for a random sample of incontinence care episodes each week. 

Results: 799 patients with incontinence (9645 incontinence care episodes). There were significant differences in the proportion of incontinence care episodes using specific product-types between the pre- and post-intervention groups, with the greatest increase for treatment/prevention products (55.2 % versus 82.8 %; p < 0.001) and decrease for underpads/bed pads (28.5 % versus 12.9 %; p < 0.001). There was a significant decrease in mean total product cost per incontinence care episode between these groups (AU$2.64 versus AU$2.35; p < 0.001). There was a significant increase in mean staff cost per incontinence care episode between these groups (AU$9.65 versus AU$10.09; p = 0.001), driven by increases in the mean number of staff and time spent per episode. There was an increase in mean total cost per incontinence care episode (AU$0.15) between these groups but not significant (p = 0.344). 

Conclusion: There was a significant decrease in mean total product cost per incontinence care episode in the intervention group. There was no significant change in mean total incontinence care cost per episode associated with the intervention, suggesting hospitals adopted IMBED with minimal extra expenses. There was streamlined resource usage and reductions in products not supported by evidence-based guidelines.