Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

ehabilitation costs are included, HBOT treatment of diabetic wounds could be
potentially cost saving in terms of major amputations.
Minor amputation
Two studies of HBOT in diabetic wounds (Doctor et al 49 and Faglia et al 47 ) reported
increases in the risk of minor amputations following HBOT compared to comparison
therapies, although none reached statistical significance. The pooled absolute risk
difference indicates an increase of 9 percent (95% CI: -8%, 25%) in the number of minor
amputations experienced by subjects following exposure to HBOT (Figure 7).
If it is assumed there are no cost offsets from reduced amputations then HBOT, with a
cost per patient of $6,941 and a risk reduction in total amputations of 11%, has a cost
per amputation avoided of $63,100 and the cost per major amputation avoided is
$34,705.
Although the increased risk of minor amputations is not statistically significant, it might
be reasonable to offset the cost savings from major amputations with the cost of a
possible increase in minor amputations.
The cost of a minor amputation of the toe or forefoot is approximated by the cost of
AN-DRG 428 – Foot Procedures of $2,194 with an average length of stay of 2.7 days. 121
This DRG cost may not be an accurate cost of amputations of the toe or forefoot
associated with diabetes, but is used here to approximate the cost of a minor amputation,
in the absence of more precise data.
The incremental cost-effectiveness analysis of HBOT per amputation avoided is shown
in Table 78.
Table 78 Estimation of incremental cost per amputation avoided – 100 patients
100 patients Intervention Group
(HBOT)
Incremental treatment costs
of HBOT
Difference in cost of major
amputation (cost savings)
Difference in cost of
rehabilitation (cost savings)
Difference in cost of minor
amputation
Comparison Group
(no HBOT)
Incremental
$694,105 - $694,105
20 major amputations prevented
($296,100)
($175,160)
9 minor amputations $19,746
Net Costs $ 242,591
Major Amputations 20 avoided
Minor Amputations 9
Total Amputations 11 avoided
Incremental cost per
amputation avoided
$22,054
Including both major and minor amputation risks, the incremental cost per amputation
avoided by HBOT in the treatment of diabetic wounds is estimated to be $22,054.
84 Hyperbaric oxygen therapy