Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

• the indicative cost-effectiveness ratios are based on the clinical evidence presented in
the effectiveness assessment of this report. There remains considerable uncertainty
surrounding the clinical evidence of the effectiveness in these indications.
– in particular, the two studies of HBOT in necrotising soft tissue infections looked
at different populations of patients and study designs were disparate. Hence, no
firm conclusions can be made on the effectiveness of HBOT in necrotising soft
tissue infections.
– the assumed risk of minor amputations and wound healing in diabetic wounds is
based on inferences drawn on a small population group.
• the estimates of the cost of HBOT treatment are not precise estimates based on actual
studies, but are based on estimates of staffing and capital costs of a hyperbaric
monoplace unit, from expert opinion. Hence, the cost-effectiveness ratios presented
here are only indicative estimates which may be sensitive to more precise estimates of
the costs of HBOT treatment.
• cost offsets have been estimated from published cost data and inferences from trial
data. These inferences are tentative given that the underlying studies, even where wellconducted,
were not designed to capture resource-use data.
• the results are sensitive not only to the estimated effectiveness of HBOT but also to
the cost of treatment. In particular, the charge for doctor time is a critical element in
the costing. While it is clear that a consultant physician is usually responsible for an
HBOT service it remains uncertain how much of their time and cost should be
attributed to each case treated. Attributing a once-off Medicare fee results in a cost per
patient treated with 30 sessions of $4,499, while attributing a consultation fee for each
session results in a cost per patient treated of $6,941. In order to be conservative, the
cost of $6,941 per patient treated was adopted.
• overall, the indicative cost-effectiveness ratios in Table 84 suggest that HBOT could be
cost-effective in diabetic wounds, and necrotising soft tissue infections. It could save
resources in the treatment of diabetic wounds and necrotising soft tissue infections.
This conclusion is dependent upon the level of confidence in the trial evidence on
HBOT in these indications. The cost of $28,480 per case of osteoradionecrosis
avoided does not take into account the cost offsets associated with prevention of
osteoradionecrosis (eg avoidance of a mandibular resection).
90 Hyperbaric oxygen therapy