Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

surgical excision was obtained for 17 patients in the HBOT group versus 10 patients in
the comparison group (p=0.018). New major surgical procedures were performed on one
patient in the HBOT group versus 6 patients in the comparison group (p=0.088). No
significant differences were found in the length of hospital stay and number of wound
dressings between groups.
The healing time is likely to be similar between groups (ie. the healing time is around 50
days for both groups). HBOT therefore may be of similar efficacy to conventional
treatment, but could result in cost savings from a reduction in surgical procedures. It has
not been possible to estimate the cost of these procedures. The costs of wound dressings
between groups are also likely to be similar between groups. Hence, although there may
be potential cost savings in terms of a reduction in wound debridement and other
surgery, these have not been costed in an incremental cost-effectiveness analysis.
Osteoradionecrosis
Marx et al 59 randomised into two groups patients who had an indication for removal of
one or more teeth in a segment of the mandible that had received a documented
absorbed dose of 6,000 rads or greater and who had agreed to maintain follow-up visits
for a minimum of six months. The comparison group received aqueous penicillin G
intravenously prior to surgery and phenoxymethylpenicillin after surgery. The
intervention group was exposed to HBOT. The main outcome of interest was the clinical
diagnosis of osteoradionecrosis during follow-up. Two out of 37 patients (5.41%) in the
intervention group were diagnosed as having osteoradionecrosis during follow up,
compared to 11 out of 37 patients (29.73%) in the comparison group (p=0.0060).
An incremental cost per case of osteoradionecrosis avoided has been estimated based on
the results from Marx et al 59 The relatively low costs for the comparison group of
aqueous penicillin G and phenoxymethylpenicillin are included. Benzylpenicillin
(BenPen) 1.2g is recommended to be given intravenously half to one hour before dental
procedures (MIMS Australia, 1999); Marx et al 59 reported giving one million units prior
to surgery. For costing purposes the dosage from MIMS was used. One pack of BenPen
(injection 3g (10’s) cost $47.95 on the PBS (item no. 3399X, PBS Schedule, Feb. 2000).
500 mg of phenoxymethylpenicillin (Abbocillin-VK) was also given to patients in the
comparison group four times a day for 10 days after surgery. One pack of Abbocillin-VK
(500 mg tablets, 50’s) cost $14.57 on the PBS (item no. 3361X, PBS Schedule, Feb.
2000).
The incremental cost-effectiveness analysis is shown in Table 82. The incremental cost
per case of osteoradionecrosis avoided is estimated to be $28,480.
Table 82 Estimation of incremental cost per case of osteoradionecrosis avoided based on Marx
(1985) – 100 patients
100 patients Intervention Group
(HBOT)
Comparison Group
(penicillin G and
phenoxymethylpenicillin)
Incremental
Treatment costs $694,105 $1,357 $692,748
Cases of osteoradionecrosis 5.41 29.73 24.32
Incremental cost per case of
osteoradionecrosis avoided
$28,480
88 Hyperbaric oxygen therapy