Cost-Effectiveness of Laser Doppler Imaging in Burn Care in The Netherlands

Abstract

Background: Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate. Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary. Methods/design: A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness) and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2-5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: 'new diagnostic strategy' versus 'current diagnostic strategy'. The results of the LDI-scan will only be provided to the treating clinician in the 'new diagnostic strategy' group. The main endpoint is the effect of LDI on wound healing time. In addition we measure: a) the effect of LDI on other patient outcomes (quality of life, scar quality), b) the effect of LDI on diagnostic and therapeutic decisions, and c) the effect of LDI on total (medical and non-medical) costs and cost-effectiveness. Discussion: This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness.

Recovery of health-related quality of life after burn injuries: An individual participant data meta-analysis

“…HRQL data from the ten different studies originated from five countries, namely Belgium, Germany, Norway, Sweden and The Netherlands [4,9,10,24,25,[31][32][33][34][35]. Data was collected between 1995 and 2018.…”

Costs of burn care: A systematic review

“…We recommend that future research on cost‐effective burn care focus on reducing hospital stay length without compromising the quality of care. Our research group is currently conducting a trial of the cost‐effectiveness of laser Doppler imaging (LDI) in burn care to analyze whether LDI will lead to earlier excision and grafting and less expensive hospital stays …”

Remote Photoplethysmography for Evaluation of Cutaneous Sensory Nerve Fiber Function

“…This approach is based on the ability of cutaneous nerve fibers to mediate local vascular tone, which is manifested as blood perfusion changes. Despite various studies confirming the potential of skin for assessment of peripheral nervous system functions, such tests are still not used by clinicians as a routine procedure, which is partly due to the lack of reliability, specificity and sensitivity, partly due to the absence of simple and cost-effective instrumentation, the latter is supported by the fact that cutaneous perfusion has been extensively examined using Laser Doppler flowmetry technique, which is relatively expensive and therefore limited to a wide range of clinicians [25] including general practitioners. The cost-effective alternative could be remote photoplethysmography [26], which is a contactless optical technique for blood volume pulsation detection in the tissue using various computational algorithms [27] and relatively simple instrumentation: video camera, to detect subtle variations of back-reflected light, and appropriate light source.…”