Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

Reactive effects
A reactive effect can occur when patients are aware that they are participating in an
experimental trial and they react to the context rather than the treatment. Since all
HBOT studies were conducted under standard clinical conditions, the potential for this
type of bias would appear to be small.
What are the economic considerations?
Introduction
The purpose of this economic appraisal is to give some indication of the likely value for
money of monoplace hyperbaric oxygen therapy (HBOT) in Australia. Multiplace
chambers were not included in the appraisal as the majority of multiplace treatments are
provided through the public hospital system. The cost per patient treated in the current
public multiplace units are likely to be higher than in a monoplace unit given the wider
role of multiplace units including the provision of 24 hour emergency care. We assessed
value for money by calculating the likely extra cost per additional unit of improved health
outcome for a range of indications for HBOT. The ratio of additional cost to additional
benefit is termed the ‘incremental cost effectiveness ratio’.
The overall cost effectiveness of hyperbaric monoplace hyperbaric oxygen therapy
(HBOT) will depend on (a) the cost per course of treatment, (b) the effectiveness of
treatment in each indication treated, and (c) the mix of indications treated. Given the
high fixed cost of treatment the average cost per course of treatment will be dependent
on throughput and the degree of capacity utilisation. The effectiveness of treatment is
likely to vary across indications. The overall extra cost per unit of additional outcome or
incremental cost effectiveness ratio will be a weighted average of the cost-effectiveness in
the indications for which HBOT is used, where the weights are the share of capacity
used. Given that the indications do not have homogeneous outcomes, it was not possible
to calculate a single cost effectiveness ratio.
No published cost-effectiveness studies or cost studies of HBOT in Australia were
found. A series of indicative cost-effectiveness ratios were calculated for a number of
indications for HBOT which have shown some clinical evidence of effectiveness. The
indicative cost-effectiveness analysis in this appraisal uses costs of HBOT treatment
based on expert opinion combined with the results from the effectiveness assessment in
this report. It does not represent a full economic analysis of the value of HBOT. It is
limited by data on effectiveness from the clinical trials reviewed. Resource use associated
with monoplace hyperbaric oxygen therapy has been estimated using a combination of
data from clinical trials and expert opinion. Some very limited modelling was done to
generalise resource use associated with disease treatment pathways. The estimated direct
cost of HBOT in a monoplace unit has not been based on a prospective study of
treatment in practice. Nor have the implications for disease management been fully
assessed. The appraisal represents only an indication of the potential cost effectiveness of
monoplace HBOT, rather than a complete and detailed estimate of the cost effectiveness
analysis of the technology.
Cost of HBOT
The cost of HBOT is composed of capital and operating costs. Operating costs include
staff, maintenance and overhead costs. The cost per session and per treatment depends
on the duration and number of sessions per annum. Two studies on the use of HBOT in
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