Download the full report (130 p.)

ii Hyperbaric Oxygenation KCE Reports 74C
Next, there is low quality evidence based on small and heterogeneous trials for the nonefficacy
of HBOT on the avoidance of long-term neurological sequels of carbon
monoxide intoxication in comparison with normobaric oxygen therapy. For the shortterm
therapeutic effects on carbon monoxide poisoning, no RCTs have been conducted
and current therapy is based on in-vitro and animal models and on theoretical
reasoning. Because of the wide consensus on its effectiveness for this indication in the
hyperbaric community, future larger and well conducted RCTs should be conducted to
reach definitive scientific conclusions for this indication.
Finally, for the other mentioned indications, there is very low quality evidence or no
evidence for the efficacy of adjuvant HBOT. Endorsement for these indications by
scientific societies and health insurers is mainly consensual and only larger and well
conducted RCTs can support or refute the appropriateness of HBOT.
ECONOMIC EVALUATION
A systematic literature review was performed to identify full economic evaluations of
HBOT. The objective was to determine whether adjuvant HBOT is a cost-effective
option compared with standard care for several indications. Seven full economic
evaluations were identified covering four indications, i.e. diabetic foot ulcers, necrotising
soft tissue infections, osteoradionecrosis, and non-diabetic wounds.
All studies showed severe limitations for both the incremental cost and for the benefit
calculations. Therefore, they can only be seen as an indication that HBOT may be a
cost-effective treatment under very specific assumptions of effectiveness and costs.
They do not provide good evidence that HBOT is indeed a cost-effective treatment.
The suggestion that HBOT could be clinically effective, could improve Quality of Life
(QoL), and could reduce health care costs under certain indications urges the need for
further large multi-centre randomised trials to find out whether or not this is real. At
the same time that effectiveness data would be collected, better quality cost data should
also be gathered. As long as adequate effectiveness and cost data are lacking, proper
economic evaluations can not be performed.
BELGIAN SITUATION
Belgian Health Insurance provides reimbursement for the first and second day of
HBOT. On January 1, 2008, the HBOT tariff level was set at €64.63 and €48.47 for the
first and second treatment day, respectively. The reimbursement level is 100%. The
nomenclature does not explicitly restrict HBOT to specific indications, but in theory
HBOT may only be charged when the patient is in a life-threatening situation. In reality,
however, this is subject to a relatively broad interpretation. The expenditures for
HBOT by the national health insurance are quite small. In 2006, €83 000 was paid for
approximately 1 400 sessions, mainly due to the current restricted reimbursement. We
estimated that less than 9% of all HBOT sessions were reimbursed during that year.
There are currently twelve centres in Belgium with hyperbaric facilities, two of them
military centres. Most often, HBOT is used for hearing disorders and post-radiotherapy
tissue damage, respectively 32% and 30% of all treatment sessions, but indications that
are being treated vary widely between centres. Occupancy rates show that there are no
apparent capacity problems and the geographic distribution seems adequate.
The largest cost component for HBOT is the personnel cost (~50-75% for multiplace
chambers), followed by the investment cost (~15-30%). The cost of oxygen and
compression is only marginal. The price per session for the hospital depends, among
others, on the number of sessions per day, the occupancy rate, the type of hyperbaric
chamber, etc. For example, the average cost of running a monoplace chamber per
patient and per session is significantly higher compared to a multiplace chamber. Since
personnel costs is the most important cost driver, it is important to work efficiently.
Having fewer sessions per day in combination with a higher occupancy rate is more
beneficial.