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76 Hyperbaric Oxygenation Therapy KCE Reports 74 Figure 37. One-way sensitivity analysis: impact of equipment lifetime on cost per session (6-place chamber, two sessions per day, and 90% occupancy rate) cost per session 90 80 70 60 50 40 30 20 10 5.9.7 Discussion 0 81 81 80 79 79 79 78 78 77 77 77 20 21 22 23 24 25 26 27 28 29 30 equipment lifetime The largest cost component of the hyperbaric therapy is the personnel cost (48-77% varying from scenario for multiplace chambers), followed by the investment cost of the hyperbaric chamber (15-32%). The cost of oxygen and pressurized air is only marginal (1-6%). The cost of running a monoplace chamber is significantly higher than that of a multiplace chamber. If a monoplace chamber is used one session a day with an occupancy rate of 90%, the cost per session is on average €311, compared to the cost of a 6- and 12-place of €102 and €58, respectively, taking into account the same number of sessions per day (one session) and occupancy rate (90%). The significantly larger cost for the monoplace chamber is driven by the higher average personnel cost per patient and the relatively larger investment cost per patient (in absolute numbers). Furthermore, and not surprisingly, we observe that a higher occupancy rate and more sessions per day result in a lower average cost per session. Moreover, we also notice that in order to control the personnel costs, it is more cost-efficient to work fewer sessions per day with a higher occupancy rate, than vice versa. For example, in a 12place chamber, one session per day with a 90% occupancy rate results in an average cost per session of €58. In contrast, three sessions per day with a 30% occupancy rate, offering the same amount of patient sessions, results in an average cost of €107. Currently, HBOT centres offer one or two sessions per day. With two sessions per day and an occupancy rate of 90%, a monoplace chamber offers 432 treatment sessions per year. This is nearly 2 600 and 5 200 patient sessions per year for a 6-place and 12-place chamber, respectively. Currently, there is no shortage of capacity since several centres have a lower occupancy rate and because more treatment sessions per day could be offered.
KCE Reports 74 Hyperbaric Oxygenation Therapy 77 Key points • In Belgium, there are ten civil and two military centres with a hyperbaric chamber. • According to data from these centres, more than 2 000 patients were treated in 2006 and more than 16 000 sessions were given. • For less than 9% of all sessions, there was a partial reimbursement from health insurance. • The Belgian HBOT chambers are predominantly used for two indications: hearing disorders (32% of all treatment sessions) and radio induced lesions (30% of all sessions). • There is a large variation in patient mix from centre to centre. • The current fee-for-service codes leave room for a relatively broad interpretation. In daily practice, HBOT centres apply the codes in various ways. • On the condition that the hyperbaric chamber is efficiently run, HBOT can cost less than €100 per patient per session. • The major cost driver is the personnel cost. It is therefore more efficient to work fewer sessions per day with a higher occupancy rate than vice versa. • A 6-place and 12-place chamber can offer respectively 2 600 and 5 200 patient treatment sessions per year (two sessions per day and 90% occupancy rate). • There is no capacity problem and geographic distribution seems sufficient.
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