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68 Hyperbaric Oxygenation Therapy KCE Reports 74 A monoplace chamber must be inspected at ten years and if satisfactory can be used for another ten years. In line with the MSAC (2000) report 69 and analysis of Treweek et al. 133 , an average lifetime of ten years is assumed for monoplace chambers. An annual equivalent cost (AEC) was calculated over a period of 25 and ten years for a multi- and monoplace, respectively. According to the KCE guidelines, 134 a discount rate of 3% was applied using the following formula: 72 5.9.2 Operational costs K = AEC + AEC/(1 + r) + AEC/(1 + r) 2 + … AEC/(1 + r) n-1 � AEC = K / (An-1,r + 1) • AEC = annual equivalent cost • n = useful life of equipment • r = discount rate (3%) • A(n,r) = the annuity factor (n years at interest rate r) • K = purchase price In this cost analysis, the operational costs contain the following items: personnel, equipment maintenance, oxygen and compressed air, patient consumables, general maintenance, and overhead. 5.9.2.1 Personnel requirements According to ECHM recommendations, a minimum work force is necessary to ensure safety. For a multiplace chamber, a physician, a care-attendant (nurse) and an operator should be present. For a monoplace chamber, only a physician and an operator are required. We assumed that the physician is still able to perform other tasks at e.g. the emergency unit. A 50% presence for HBOT was assumed. Additionally, a person for emergency assistance should be available. Furthermore, there are also personnel costs for the management and administration of the hyperbaric chamber. In most centres, a session takes 90 minutes. In some centres, however, a number of breaks are given, increasing the required time to 99, 110 or 120 minutes. We took into account the shortest treatment session of 90 minutes. On top of this, another 30 to 60 minutes per session is required for patient assessment, treatment preparation and quality assurance. 69 An overview of our assumptions is provided in Table 16, Table 17 and Table 18. In order to calculate the total number of sessions that can be given per year, it is assumed that the chamber is operated 5 days per week and 48 weeks per year. Table 16. Required time and personnel during a treatment session For multiplace scenarios Patient assessment, treatment preparation and finalization and quality assurance Required time Required personnel 60 min 1 physician (50%) 1 nurse Patient treatment 90 min 1 physician (50%) 1 attendant (nurse) 1 operator (nurse) For monoplace scenarios Patient assessment, treatment preparation and finalization and quality assurance 60 min 1 physician (50%) 1 nurse Patient treatment 90 min 1 physician (50%) 1 operator (nurse)
KCE Reports 74 Hyperbaric Oxygenation Therapy 69 Table 17. Required time for management and administration Required time Required personnel For multiplace scenarios Administration For monoplace scenarios 30 min. fixed administration per session + 6 min. per patient 1 nurse Administration 30 min. per session 1 nurse Table 18. Weekly/Yearly work schedule Treatment days/week 5 days/week Treatment weeks/year 48 weeks/year For the cost of the hyperbaric physician, the average cost of an emergency care specialist or an anaesthesiologist with an average seniority of 20 years at two university hospitals is used. For the cost of a nurse, the average cost of an A1 and A2 nurse with an average seniority of 20 years at two university hospitals is used (Table 19). The assumptions to calculate the cost per hour for each of the staff members are shown in Table 20. Table 19. Average cost per FTE Average Yearly Cost Average Gross wage per Employee per FTE* FTE Physician 151 000 101 000 Nurse (average A1, A2) 58 500 37 500 Nurse A1 62 000 40 000 Nurse A2 FTE: full time equivalent 55 000 35 000 * including gross wage, employer’s contributions (35% on gross wage), holiday pay (legally at 92% of gross month wage), end of year pay (~30 % of gross month wage + 35% employer’s contributions). Including also an indirect personnel cost of 4 000€ per FTE for HR services, HR administration, office equipment, IT, telecom and other administrative costs (source: UZA). Table 20. Personnel parameters Working hours / week per FTE 38 Working weeks / year per FTE 45 Taking into account holidays % productive hrs / total 90% Taking into account sick time and other service- working hrs related duties (general meetings, training, …) 5.9.2.2 Equipment maintenance For a 6-person multiplace chamber, we received an estimate for equipment maintenance cost from AZ Sint Jan Brugge. For a 12-person multiplace chamber, we received an estimate from UZ Antwerpen. This maintenance cost includes preventive and corrective maintenance, replacement of components and a maintenance contract with the supplier. As a percentage of the above mentioned investment price, the maintenance cost varied from 1.4% to 1.5%. Therefore, we assume a mean maintenance cost of 1.5% (with a range of 1 to 2%) (Table 21).
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