title: Cost-Effectiveness of Laser Doppler Imaging in Burn Care in The Netherlands: A Randomized Controlled Trial.
abstract: BACKGROUND
  In patients with burns, an early accurate diagnosis of burn depth facilitates optimal treatment. Laser Doppler imaging combined with clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of laser Doppler imaging on therapeutic decisions, clinical outcomes, and costs are unknown.
  
  
  METHODS
  A randomized controlled trial was conducted in the Dutch burn centers, including 202 patients with burns of indeterminate depth. In the standard care group, estimation of burn depth was based on clinical assessment only; in the laser Doppler imaging group, clinical assessment and laser Doppler imaging were combined. Primary outcome was time to wound healing. Furthermore, therapeutic decisions and cost-effectiveness were analyzed.
  
  
  RESULTS
  Mean time to wound healing was 14.3 days (95 percent CI, 12.8 to 15.9 days) in the laser Doppler imaging group and 15.5 days (95 percent CI, 13.9 to 17.2 days) in the standard care group (p = 0.258). On the day of randomization, clinicians decided significantly more often on operative or nonoperative treatment in the laser Doppler imaging group (p < 0.001), instead of postponing their treatment choice. Analyses in a subgroup of admitted patients requiring surgery showed a significant earlier decision for surgery and a shorter wound healing time in the laser Doppler imaging group. Mean total costs per patient were comparable in both groups.
  
  
  CONCLUSIONS
  Laser Doppler imaging improved therapeutic decisions. It resulted in a shorter wound healing time in the subgroup of admitted patients requiring surgery and has the potential for cost savings of €875 per scanned patient.
authors.affiliation: Rotterdam, Amsterdam, Beverwijk, and Groningen, The Netherlands From the Association of Dutch Burn Centres, Maasstad Hospital; the Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre; the Association of Dutch Burn Centres, Red Cross Hospital; the Association of Dutch Burn Centres, Martini Hospital; and the Department of Public Health, Erasmus Medical Centre.
authors.forename: M Jenda
authors.initials: MJ
authors.lastname: Hop
authors.forename: Carlijn M
authors.initials: CM
authors.lastname: Stekelenburg
authors.forename: Jakob
authors.initials: J
authors.lastname: Hiddingh
authors.forename: Hedwig C
authors.initials: HC
authors.lastname: Kuipers
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Nieuwenhuis
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
authors.forename: Margriet E
authors.initials: ME
authors.lastname: van Baar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002053:Burn Units; D002056:Burns / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult