title: Cost-Effectiveness of a Nonpharmacological Intervention in Pediatric Burn Care.
abstract: OBJECTIVE
  To report the cost-effectiveness of a tailored handheld computerized procedural preparation and distraction intervention (Ditto) used during pediatric burn wound care in comparison to standard practice.
  
  
  METHODS
  An economic evaluation was performed alongside a randomized controlled trial of 75 children aged 4 to 13 years who presented with a burn to the Royal Children's Hospital, Brisbane, Australia. Participants were randomized to either the Ditto intervention (n = 35) or standard practice (n = 40) to measure the effect of the intervention on days taken for burns to re-epithelialize. Direct medical, direct nonmedical, and indirect cost data during burn re-epithelialization were extracted from the randomized controlled trial data and combined with scar management cost data obtained retrospectively from medical charts. Nonparametric bootstrapping was used to estimate statistical uncertainty in cost and effect differences and cost-effectiveness ratios.
  
  
  RESULTS
  On average, the Ditto intervention reduced the time to re-epithelialize by 3 days at AU$194 less cost for each patient compared with standard practice. The incremental cost-effectiveness plane showed that 78% of the simulated results were within the more effective and less costly quadrant and 22% were in the more effective and more costly quadrant, suggesting a 78% probability that the Ditto intervention dominates standard practice (i.e., cost-saving). At a willingness-to-pay threshold of AU$120, there is a 95% probability that the Ditto intervention is cost-effective (or cost-saving) against standard care.
  
  
  CONCLUSIONS
  This economic evaluation showed the Ditto intervention to be highly cost-effective against standard practice at a minimal cost for the significant benefits gained, supporting the implementation of the Ditto intervention during burn wound care.
authors: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia. Electronic address: nadia.brown@uqconnect.edu.au.
authors: Nadia J
authors: NJ
authors: Brown
authors: Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; School of Population Health, The University of Queensland, Brisbane, Australia.
authors: Michael
authors: M
authors: David
authors: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors: Leila
authors: L
authors: Cuttle
authors: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia.
authors: Roy M
authors: RM
authors: Kimble
authors: Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
authors: Sylvia
authors: S
authors: Rodger
authors: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA.
authors: Hideki
authors: H
authors: Higashi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001458:Bandages / Q000191:economics; D002056:Burns / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D003198:Computer Simulation; D034201:Computers, Handheld / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D008297:Male; D018803:Models, Economic; D059408:Pain Management / Q000191:economics* / Q000295:instrumentation; D011091:Polyesters / Q000191:economics / Q000627:therapeutic use; D011095:Polyethylenes / Q000191:economics / Q000627:therapeutic use; D015397:Program Evaluation; D011446:Prospective Studies; D011793:Queensland; D062326:Re-Epithelialization; D012189:Retrospective Studies; D012828:Silicones / Q000191:economics / Q000627:therapeutic use; D013813:Therapy, Computer-Assisted / Q000191:economics* / Q000295:instrumentation; D016896:Treatment Outcome
chemical_list: C117408:Acticoat; D011091:Polyesters; D011095:Polyethylenes; D012828:Silicones; C114834:mepitel
keywords: burns; child; cost-effectiveness; economic evaluation; nonpharmacological intervention; randomized controlled trial; re-epithelialization