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82 Hyperbaric Oxygenation Therapy KCE Reports 74 The majority of units providing services to the NHS are registered with the British Hyperbaric Association which is not regulatory, but aims to provide standards for benchmarking purposes and to facilitate research. j There are 18 centres member of the British Hyperbaric Association (Table 32). Table 32. Hyperbaric chambers in the UK Location Chamber category Aberdeen 1 Gosport / Cosham 1 Great Yarmouth 1 Guernsey 1 Hull 1 Isle of Cumbrae 3 Isle of Man 2 Jersey 3 London (Whipp's Cross) 1 London (Highgate) 1 Manchester 4 Oban 2 Orkney 2 Peterborough 4 Plymouth (DDRC) 1 Poole 1 TWI Technology Centre unknown Wirral 1 Source: http://www.hyperbaric.org.uk/memberChambers.htm 6.3.2 Covered indications Unlike those countries in which the range of health care benefits covered under social or private health insurance plans is defined explicitly, the NHS does not specify an explicit list of services to be provided. 136 District health authorities are free to contract service agreements with hospitals and other providers, specifying what services are to be provided and the terms on which they are to be supplied. For HBOT, district health authorities tend to use the UHMS guidelines, 8 but more and more of them are only paying for HBOT when there is RCT evidence to back its use. Some health authorities only fund the treatment of decompression illness. 6.3.3 Fees for HBOT Fees are determined under the service agreements contracted between the different district health authorities and providers. As no national fixed fees are set, these may vary widely from district to district. Based on personal communication with Plymouth Hyperbaric Medical Centre, the cost range per hyperbaric session is as follows at DDRC (Diving Diseases Research Centre UK): • Standard session of 90 minutes: £96 - £240 (for non-emergency cases) • Emergency < 5hrs: £5 736.42 / 2 hrs + £1 032.55 /h • Emergency 6 – 17 hrs: £9 695.53 + £860.47 /h • Emergency >18 hrs: £19 274.35 + £114.72 /h • USNTT6: at the same rate of emergency treatments Emergency cases are for CO intoxication and diving accidents, necrotising fasciitis or gas gangrene. It is, however, difficult to compare the incidence and prevalence of indications between countries because of possible differences in definitions. CO intoxication, for example, appears to occur less frequently in the UK: only 36 fatalities and 128 casualties were recorded in 2006 for the whole of the UK, 137 compared to j Source: www.dh.gov.uk/en/PolicyAndGuidance/HealthAndSocialCareTopics/SpecialisedServicesDefinition/DH_400 1709
KCE Reports 74 Hyperbaric Oxygenation Therapy 83 approximately 700 patients treated yearly for this indication in Belgian HBOT centres (see chapter 5). 6.4 UNITED STATES The US had 296.41 million inhabitants in 2005 on an area of 9.38 million km 2 . k There are 603 US centres listed on the UHMS website that have one or more hyperbaric chambers. Most of them are located in Florida (78) and Texas (75). 6.4.1 Medicare covered indications l Program reimbursement for HBOT therapy is limited to that which is administered in a chamber (including the one man unit) and is limited to the following conditions: • Acute carbon monoxide intoxication, • Decompression illness, • Gas embolism, • Gas gangrene, • Acute traumatic peripheral ischemia: HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened. • Crush injuries and suturing of severed limbs. As in the previous conditions, HBOT would be an adjunctive treatment when loss of function, limb, or life is threatened. • Progressive necrotizing infections (necrotizing fasciitis), • Acute peripheral arterial insufficiency, • Preparation and preservation of compromised skin grafts (not for primary management of wounds), • Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management, • Osteoradionecrosis as an adjunct to conventional treatment, • Soft tissue radionecrosis as an adjunct to conventional treatment, • Cyanide poisoning, • Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment, • Diabetic wounds of the lower extremities in patients who meet the following three criteria: o Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes; o Patient has a wound classified as Wagner grade III or higher; and o Patient has failed an adequate course of standard wound therapy. The use of HBO therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care. Standard wound care in patients with diabetic wounds includes: • Assessment of a patient’s vascular status and correction of any vascular problems in the affected limb if possible, k Source: OECD demographic data 2007 l Source: Medicare National Coverage Determinations Manual, chapter 1, Part 1 (Rev. 77, 09-12-07) (Section .29 Hyperbaric Oxygen Therapy) (Rev. 48, Issued: 03-17-06; *-/*/Effective/Implementation Dates: 06-19-06)
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