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KCE Reports 74 Hyperbaric Oxygenation Therapy 49<br />
Therefore, <strong>the</strong> studies only indicate <strong>the</strong> potential cost effectiveness of HBOT versus<br />
standard <strong>the</strong>rapy. Fur<strong>the</strong>r research is necessary to estimate <strong>the</strong> real-world costeffectiveness<br />
of HBOT.<br />
4.3.2 Necrotising soft tissue infections<br />
4.3.2.1 Medical Services Advisory Committee 69<br />
The Australian HTA <strong>report</strong> (2000) also included an analysis for <strong>the</strong> indication of<br />
necrotising soft tissue infections. In this <strong>report</strong>, two studies were found that looked at<br />
this indication. 112, 113 They looked at <strong>the</strong> proportion of patients who survived following<br />
<strong>the</strong> diagnosis of necrotising soft tissue infections. Both showed that HBOT was<br />
associated with improved survival, only one being statistical significant. 113 In this study,<br />
76.5% of patients in <strong>the</strong> intervention group survived compared to 33.3% in <strong>the</strong><br />
comparison group, a difference of 43.1% (95% CI: 9.7%, 76.6%, p=0.0202). With a<br />
HBOT treatment cost of AUD6 941 (30 sessions), this resulted in an incremental cost<br />
per death avoided of AUD16 105.<br />
Sensitivity analysis using <strong>the</strong> upper and lower bound of <strong>the</strong> 95% CI suggested this cost<br />
to be AUD9 061 and AUD71 557, respectively. Results were also very sensitive to <strong>the</strong><br />
number of sessions and sharing of operating costs between units.<br />
Similar as for diabetic wounds, <strong>the</strong> authors concluded monoplace HBOT could<br />
potentially be cost-effective in <strong>the</strong> treatment of necrotising soft tissue infections and<br />
could save resources. They recognised, however, that <strong>the</strong> true cost of monoplace<br />
HBOT may be considerably different and that <strong>the</strong>re was considerable uncertainty<br />
surrounding <strong>the</strong> true effectiveness of HBOT and associated health cost offsets in this<br />
indication.<br />
4.3.2.2 Comments<br />
Again, great uncertainty regarding costs and effects are present in <strong>the</strong> economic<br />
evaluation. The authors remark that no firm conclusions could be reached on <strong>the</strong><br />
effectiveness of HBOT in necrotising soft tissue infections since <strong>the</strong> two studies of<br />
HBOT in this indication looked at different populations and had different study<br />
designs. 69 Only one of <strong>the</strong> studies also <strong>report</strong>ed a statistically significant positive result<br />
on survival. This endpoint used in <strong>the</strong> economic evaluation is difficult to interpret: “while<br />
a cost per death avoided of $16 105 might appear to be a very acceptable cost, it may be that<br />
<strong>the</strong> survival curves of <strong>the</strong> treated patients and <strong>the</strong> comparator group converge quickly and <strong>the</strong><br />
life years gained may be very small.” 69<br />
In conclusion, HBOT could potentially be cost effective in <strong>the</strong> treatment of necrotising<br />
soft tissue infections. However, <strong>the</strong>re is great uncertainty surrounding <strong>the</strong> true<br />
effectiveness of HBOT versus standard <strong>the</strong>rapy and cost offsets are not very clear.<br />
4.3.3 Osteoradionecrosis<br />
4.3.3.1 Dempsey et al. 82<br />
In this retrospective Canadian study (1997), a cost effectiveness analysis of hyperbaric<br />
<strong>the</strong>rapy in osteoradionectosis of <strong>the</strong> mandible was performed from a societal<br />
perspective. Twenty-one patients who underwent HBOT at <strong>the</strong> Hamilton Civic<br />
Hospitals (Ontario) were included. A hypo<strong>the</strong>tical control group was created and<br />
matched to <strong>the</strong> study group. Costs were given in 1995 CAD and discounted at 5%.<br />
The researchers looked at how many patients healed. Outcomes for <strong>the</strong> hypo<strong>the</strong>tical<br />
group undergoing conservative <strong>the</strong>rapy were taken from <strong>the</strong> literature. From <strong>the</strong>se<br />
expected values, 65% of patients would heal before reconstructive surgery, 23% would<br />
heal after reconstructive surgery and 12% would not have <strong>the</strong>ir disease resolved. Due<br />
to large variations in values <strong>report</strong>ed in literature, <strong>the</strong> percentage of patients healing<br />
before reconstructive surgery was varied over a wide range (8-75%) in a sensitivity<br />
analysis.