Real-world application of an integrated MCDA-economic framework in continence care technology: a hospital-based case study.

Abstract

Introduction: Hospital-based Health Technology Assessment (HTA) supports transparent decisions about adopting medical technologies by balancing practical benefits against clinical, organizational, and economic consequences. This study evaluated a single-use continence care system using an integrated decision-support framework.

Methods: The single-use system, based on disposable absorbent components, was compared with the standard reusable bedpan/urinal pathway, including washing and reprocessing. The assessment combined Multi-Criteria Decision Analysis (MCDA), Budget Impact Analysis (BIA), Cost-Consequence Analysis (CCA), a 30-day field test across inpatient units at two hospital sites, and an implementation-specific questionnaire. During the field test, 168 admissions were recorded. MCDA used a weighted aggregate score, while the economic analysis adopted the hospital perspective over three years. Deterministic sensitivity analyses examined economic inputs and MCDA domain weights.

Results: The single-use system offered perceived advantages in ease of use, hygiene, and odor reduction. However, these did not offset limited supporting evidence, lower patient-comfort ratings, operational issues, and higher costs. The MCDA score decreased from 4.80 for standard care to 2.60 for the single-use system (difference: -2.20). Cost per patient increased from €0.65 to €1.00, an incremental cost of €0.35. The three-year budget impact was €2,634 and remained within the local affordability threshold. As the technology was more costly and produced lower overall MCDA value, it was classified as dominated. Sensitivity analyses did not alter the recommendation.

Conclusion: The integrated MCDA-economic framework supported transparent hospital-level decision-making. Affordability and perceived practical advantages were insufficient to justify routine adoption of the single-use continence care system.