Adjunctive Hyperbaric Oxygen Therapy for Diabetic Foot Ulcer: An Economic Analysis

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Technology and Condition
Adjunctive hyperbaric oxygen therapy(HBOT) for diabetic foot ulcer (DFU), acomplication of diabetes mellitus, in adults and children.

The Issue
An estimated 240,000 to 300,000 Canadianswill have a DFU in their lifetime. DFU isassociated with major morbidity, in manycases leading to lower extremity amputation(LEA). Use of HBOT may increase thesuccess of healing DFU, and decrease the riskof infection and LEA. There is uncertaintyregarding the cost effectiveness of using thistechnology versus standard care.

Methods
Controlled studies that compared adjunctiveHBOT for DFU with standard wound care inpatients of all ages were identified through aliterature search. Summary estimates werederived for proportions of LEAs and healedulcers in patients who received adjunctiveHBOT, and those who had standard care only.Using a decision model, the cost effectivenessof adjunctive HBOT was compared with thatof standard care alone for the treatment of65-year-old patients A health services budgetimpact analysis was conducted using prevalencedata from the literature, and utilization datafrom Alberta and Canada.

Implications for Decision Making

• Adjunctive HBOT for DFU is moreeffective than standard care alone. The proportion of major LEAs can decrease from32% among patients receiving standard careto 11% among those receiving adjunctiveHBOT. There was a decrease in theproportion of unhealed wounds with HBOT;the reverse was true for minor LEAs.
• HBOT for DFU is cost effective comparedwith standard care. The 12-year cost for apatient receiving HBOT was C$40,695compared to C$49,786 for standard care alone,with an associated increase of 0.63 qualityadjustedlife years (QALYs) (3.01 QALYs forstandard care to 3.64 QALYs for thosereceiving HBOT)
• HBOT requires additional resourcesand planning. The estimated costs to treatall prevalent DFU cases in Canada isC$14 million per year for four years. Anestimated 179 additional monoplacechambers or 19 seven-person multiplaceHBOT chambers would be required.
• Optimal use will require additionalconsiderations. Guidelines would need to beapplied to identify those patients mostappropriately treated with HBOT. As standardcare evolves and better quality studies becomeavailable, the estimated comparativeadvantage of HBOT may change.

This summary is based on a health technology assessment available from CADTH’s web site (www.cadth.ca):Hailey D, Jacobs P, Perry DC, Chuck A, Morrison A, Boudreau R. Adjunctive Hyperbaric Oxygen Therapy forDiabetic Foot Ulcer: An Economic Analysis.