Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Subjects exposed to HBOT are about 40 times more likely to experience healing of their
lesions compared to those receiving comparison therapies (Figure 8).
The sample sizes in the studies which included wound healing as an outcome are too
small to safely infer effectiveness. Therefore, an incremental cost per wound healed can
not reasonably be estimated.
Non-diabetic wounds
Hammarlund and Sundberg 51 exposed two groups of 8 subjects with leg ulcers of more
than one-year’s duration, to different concentrations of oxygen (intervention group 100
percent oxygen while the comparison group received air) in a multiplace chamber. The
frequency of exposure was five times a week for a total of 30 sessions.
The study looked at the mean changes in wound area over the course of therapy (Table
20). At 4 and 6 weeks, there were statistically significant decreases in the wound areas of
the HBOT group compared to the comparison group. The intervention group had a
35.7% decrease in wound area from baseline, compared to 2.7% decrease in wound area
for the comparison group, at 6 weeks.
This suggests that HBOT treatment of chronic leg ulcers might result in an expected one
third reduction in wound area for a treatment cost of $6,941 per patient. The clinical
significance of this outcome or its significance to patient welfare in the longer term is not
sufficiently clear to assess whether this is an acceptable figure.
Necrotising soft tissue infections
The effectiveness assessment (Table 21) reports on two studies from the published
literature that looked at necrotising soft tissue infections in general. Both studies showed
that HBOT was associated with survival, but only Riseman et al 53 reached statistical
significance. 76.5% of patients in the intervention group survived compared to 33.3% in
the comparison group, a difference of 43.1% (95% CI: 9.7%, 76.6%, p=0.0202).
An incremental HBOT treatment cost per death avoided can be estimated, based on the
results from Riseman et al 53 The incremental cost-effectiveness analysis is shown in Table
80. The incremental HBOT treatment cost per death avoided is estimated to be $16,105,
in patients with necrotising soft tissue infections. The analysis above is based on an
average of 30 HBOT sessions per patient (for all indications) (Table 24). Riseman et al 53
reported a total of 10 treatments per patient. Using an estimate of 10 sessions per patient
results in a total monoplace chamber cost (operating and capital costs based on full
capacity) per treatment of $231.37 and a total cost per patient of $2,314, which then
lowers the incremental cost per death avoided. However the duration of survival in each
group is unknown. An estimated cost per survivor is less meaningful than a cost per
survival time. While a cost per death avoided of $16,105 might appear to be a very
acceptable cost, it may be that the survival curves of the treated patients and the
comparator group converge quickly and the life years gained may be very small. In
addition a significant positive result was only reported in one study.
86 Hyperbaric oxygen therapy