BACKGROUND: Blended physiotherapy, in which physiotherapy sessions and an online application are integrated, might support patients in taking an active role in the management of their chronic condition and may reduce disease related costs. The aim of this study was to evaluate the cost-effectiveness of a blended physiotherapy intervention (e-Exercise) compared to usual physiotherapy in patients with osteoarthritis of hip and/or knee, from the societal as well as the healthcare perspective.METHODS: This economic evaluation was conducted alongside a 12-month cluster randomized controlled trial, in which 108 patients received e-Exercise, consisting of physiotherapy sessions and a web-application, and 99 patients received usual physiotherapy. Clinical outcome measures were quality-adjusted life years (QALYs) according to the EuroQol (EQ-5D-3 L), physical functioning (HOOS/KOOS) and physical activity (Actigraph Accelerometer). Costs were measured using self-reported questionnaires. Missing data were multiply imputed and bootstrapping was used to estimate statistical uncertainty.RESULTS: Intervention costs and medication costs were significantly lower in e-Exercise compared to usual physiotherapy. Total societal costs and total healthcare costs did not significantly differ between groups. No significant differences in effectiveness were found between groups. For physical functioning and physical activity, the maximum probability of e-Exercise being cost-effective compared to usual physiotherapy was moderate (< 0.82) from both perspectives. For QALYs, the probability of e-Exercise being cost-effective compared to usual physiotherapy was 0.68/0.84 at a willingness to pay of 10,000 Euro and 0.70/0.80 at a willingness to pay of 80,000 Euro per gained QALY, from respectively the societal and the healthcare perspective.CONCLUSIONS: E-Exercise itself was significantly cheaper compared to usual physiotherapy in patients with hip and/or knee osteoarthritis, but not cost-effective from the societal- as well as healthcare perspective. The decision between both interventions can be based on the preferences of the patient and the physiotherapist.TRIAL REGISTRATION: NTR4224 (25 October 2013).
Objectives: In patients with burns an early accurate diagnosis of burn depth is essential to determine optimal treatment. The combination of Laser Doppler imaging (LDI) and clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of LDI on therapeutic decisions, clinical outcomes and costs are unknown. The aim of our study was to analyse the effectiveness and cost-effectiveness of LDI in burn care. The effects of LDI on decision-making, clinical outcomes, costs, and cost-effectiveness were assessed. Methods: A randomised controlled trial was conducted in all three Dutch burn centres, including subsequent patients with burns of indeterminate depth. In the standard care (SC) group, burn depth and treatment choices were based on clinical assessment only, in the other group (LDI) clinical assessment and LDI results were combined. Primary outcome was the effect of the introduction of LDI on wound healing time. The economic evaluation was performed from a societal perspective with a bottom up approach, following the micro-costing method. Results: Mean time to wound healing from randomisation was 14.3 days in the LDI group and 15.5 days in the SC group (p= 0.258). In the subgroup of clinical patients requiring surgery earlier decision for surgery and a shorter wound healing time were observed in the LDI group (16.0 versus 19.9 days, p= 0.029). Mean total costs per patient were € 18 549 versus € 18 896 (p= 0.837). Conclusions: LDI proved to provide guidance for therapeutic decisions with a significantly shorter wound healing time in the subgroup of clinical patients requiring surgery. When time to surgery can be reduced by 2.4 days, similar to the time to decision for surgery in our study, cost savings of € 794 per scanned patient can be achieved.
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.TRIAL REGISTRATION: NCT01489540.
This Professional Doctorate (PD) research focuses on optimizing the intermittency of CO₂-free hydrogen production using Proton Exchange Membrane (PEM) and Anion Exchange Membrane (AEM) electrolysis. The project addresses challenges arising from fluctuating renewable energy inputs, which impact system efficiency, degradation, and overall cost-effectiveness. The study aims to develop innovative control strategies and system optimizations to mitigate efficiency losses and extend the electrolyzer lifespan. By integrating dynamic modeling, lab-scale testing at HAN University’s H2Lab, and real-world validation with industry partners (Fluidwell and HyET E-Trol), the project seeks to enhance electrolyzer performance under intermittent conditions. Key areas of investigation include minimizing start-up and shutdown losses, reducing degradation effects, and optimizing power allocation for improved economic viability. Beyond technological advancements, the research contributes to workforce development by integrating new knowledge into educational programs, bridging the gap between research, industry, and education. It supports the broader transition to a CO₂-free energy system by ensuring professionals are equipped with the necessary skills. Aligned with national and European sustainability goals, the project promotes decentralized hydrogen production and strengthens the link between academia and industry. Through a combination of theoretical modeling, experimental validation, and industrial collaboration, this research aims to lower the cost of green hydrogen and accelerate its large-scale adoption.
