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54 Hyperbaric Oxygenation Therapy KCE Reports 74
As mentioned by Fife et al., 130 for the treatment of lower-extremity lesions, rather than
complete healing of a lesion, the objective today is more often a partial healing by
granulation to the point that epithelization can continue without further hyperbaric
therapy. As a consequence, achieving the complete healing category might not be the
best objective for cost-effective treatment of patients with HBOT. 130
4.5 CONCLUSION
HBOT may provide several benefits such as reducing length of hospital stay, reduction
in amputations, improvement in patients QoL, reduction in outpatient care, etc.
According to several authors, this could result both in increasing benefits and
decreasing costs, resulting in a cost saving treatment. For example, it seems that HBOT
could be cost-effective in the treatment of diabetic wounds. All studies, however, show
limitations for both incremental cost and benefit calculations. Therefore, they can only
be seen as an indication that HBOT may be a cost-effective treatment. They do not
provide good evidence that HBOT is a cost-effective treatment. The suggestion that
HBOT could be clinically effective, could improve QoL, and could reduce health care
costs in certain indications highlights the need for further large multi-centre trials to find
out whether or not this is the case. While evidence data would be collected, good cost
data should also be gathered. Incremental costs and benefits which are part of both the
short- and long-term treatment pathway should be taken into account. As long as good
qualitative evidence and cost data are lacking, good qualitative economic evaluations can
not be performed.
Key points
• Being an adjunct to standard therapy, HBOT is associated with increased
(initial) treatment costs.
• Even though potential harms caused by HBOT appear to be small, it is a
waste of valuable resources to use HBOT for conditions for which it is not
effective.
• Economic evaluations currently are based on insufficient data and
therefore have important limitations for both the incremental cost and
benefit calculations.
• It is not possible to estimate cost-effectiveness of HBOT without good
data on effectiveness, costs and quality of life.
• HBOT might be effective, improve QoL, and reduce costs in certain
indications. Therefore, it deserves further attention and there is need for
large multi-centre trials to gather both short- and long-term evidence
and cost data.