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88 Hyperbaric Oxygenation Therapy KCE Reports 74 Item Table 36. Overview of covered indications and fee-for-service Description Fee/Benefit 13015 HBOT, for treatment of Fee: $230.05 � soft tissue radionecrosis or Benefit: 75%/85% � chronic or recurring wounds where hypoxia can be demonstrated, 13020 for a period in the hyperbaric chamber of between 1 hour 30 minutes and 3 hours This item is funded on an interim basis and will cease on 31 October 2010. HBOT, for treatment of Fee: $233.70 � decompression illness, Benefit: 75%/85% � gas gangrene, � air or gas embolism; � diabetic wounds including diabetic gangrene and diabetic foot ulcers; � necrotising soft tissue infections including necrotising fasciitis or Fournier's gangrene; or � for the prevention and treatment of osteoradionecrosis, 13025 for a period in the hyperbaric chamber of between 1 hour 30 minutes and 3 hours HBOT for treatment of Fee: $104.50 � decompression illness, Benefit: 75%/85% � air or gas embolism, 13030 for a period in the hyperbaric chamber greater than 3 hours - per hour (or part of an hour) HBOT performed in a comprehensive hyperbaric medicine facility where Fee: $147.60 the medical practitioner is pressurised in the hyperbaric chamber for the purpose of providing continuous life saving emergency treatment, including any associated attendance - per hour (or part of an hour) Benefit: 75%/85% 6.7 Source: Medicare Benefits Schedule : http://www9.health.gov.au/mbs/search.cfm INTERNATIONAL COMPARISON: CONCLUSION There is no clear agreement on the use of HBOT when comparing the use of this therapy across countries. The acceptance of HBOT is mainly based on consensus for several indications. In proportion to the number of inhabitants and area, Belgium has a relatively large capacity of HBOT centres. With an area of about 30 500 km², Belgium has on average one HBOT centre per ~2 500 km². This is on average one centre per 3 700, 13 600, 15 500, 20 300 and 640 800 km² for the Netherlands, UK, US, France, and Australia respectively. In proportion to the number of inhabitants, only the US has a higher proportion of HBOT centres which are mainly monoplace chambers. This corresponds to about one centre per 875 000 inhabitants in Belgium. In contrast, there is on average one HBOT centre per 1.5, 1.7, 2.3, and 3.3 million inhabitants for the Netherlands, Australia, France, and the UK respectively. Key points • Internationally, reimbursement levels vary and reimbursed indications are mainly consensus based • Compared to surrounding countries, HBOT capacity is relatively high in Belgium
KCE Reports 74 Hyperbaric Oxygenation Therapy 89 7 CONCLUSIONS In this report we attempt to describe the history of hyperbaric oxygenation therapy (HBOT), the evidence for its use, the economic value of its application and cost for patients, hospitals and society, and also the current application of this technology in Belgium and in other countries. Despite the fact that HBOT has been in use for several decades, evidence on its effectiveness is remarkably poor. Although its use appears to be, under strict precautions, relatively save, it is important to evaluate this therapy carefully for several indications, to avoid overutilisation in indications where no benefit is likely, and to avoid underutilisation when potential benefits might be foregone because of lack of knowledge. Several indications have been accepted by medical scientific societies, but due to the paucity of properly randomised clinical study results, those acceptances are mainly based on a consensual decision making process rather than on an evidence based medicine approach. For a limited number of indications (mainly decompression illness) HBOT is likely to be important. For some indications there is limited evidence for benefits, for a few other indications HBOT is unlikely to be beneficial, and for several other indications HBOT might be beneficial but we just do not know. Therefore it is important to organise randomised clinical studies to sort out those uncertainties. In Table 37 we present an overview of the key results of this report.
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