Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-23T12:51:40.177Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness and budget impact of adjunctive hyperbaric oxygen therapy for diabetic foot ulcers

Published online by Cambridge University Press:  09 April 2008

Anderson W. Chuck ,
David Hailey ,
Philip Jacobs  and
Douglas C. Perry
Anderson W. Chuck
Affiliation:
University of Alberta and Institute of Health Economics
David Hailey
Affiliation:
University of Calgary and Institute of Health Economics
Philip Jacobs
Affiliation:
University of Alberta and Institute of Health Economics
Douglas C. Perry
Affiliation:
University of Alberta and Misericordia Hospital
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunct to standard methods of care for diabetic foot ulcers (DFU). Its use may decrease the risk of infection and lower extremity amputations (LEAs). As part of a Canadian assessment, we estimated the cost-effectiveness and budget impact of HBOT in this application.

Methods: We developed a decision model comparing adjunctive HBOT with standard care alone. The population was a 65-year-old cohort with DFU. The time horizon was 12 years taken from a Ministry of Health perspective. The health states were a healed wound with or without a minor LEA, an unhealed wound with no related surgery, and a major LEA. Efficacy data were based on outcomes reported in studies included in a literature review. Cost and capacity needs for treating DFU patients in Canada were estimated using prevalence data from the literature, and cost and utilization data from government records.

Results: The 12-year cost for patients receiving HBOT was CND$40,695 compared with CND$49,786 for standard care alone. Outcomes were 3.64 quality-adjusted life-years (QALYs) for those receiving HBOT and 3.01 QALYs for controls. Estimated cost to treat all prevalent DFU cases in Canada was CND$14.4–19.7 million/year over 4 years. If seven-person HBOT chambers were used, a further nineteen to thirty-five machines would be required nationally.

Conclusions: Adjunctive HBOT for DFU is cost-effective compared with standard care. Additional HBOT capacity would be needed if it were to be adopted as the standard of care throughout Canada.

Keywords

Hyperbaric oxygenationDiabetic footAmputationEconomics
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 2 , April 2008 , pp. 178 - 183
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Abidia, A, Laden, G, Kuhan, G, et al. The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers: a double-blind randomised-controlled trial. Eur J Vasc Endovasc Surg. 2003;25:513–518.CrossRefGoogle ScholarPubMed
2. Agence d'Evaluation des Technologies et des Modes d'Intervention en Santé (AETMIS). Hyperbaric Oxygen Therapy in Quebec. Montreal: AETMIS; 2000.Google Scholar
3. Alberta Health and Wellness. Schedule of medical benefits amended October 1, 2005. Edmonton: Government of Alberta. Available at: http://www.health.gov.ab.ca/professionals/somb.htm.Google Scholar
4. Alberta Health and Wellness. Health trends in Alberta – A working document. Edmonton: Government of Alberta; 2000. Available at: http://www.health.gov.ab.ca/resources/publications/Health_Trends/index.html.Google Scholar
5. Apelqvist, J, Ragnarson Tennvall, G, Larsson, J, et al. Long-term costs for foot ulcers in diabetic patients in a multidisciplinary setting. Foot Ankle Int. 1995;16:388–394.CrossRefGoogle ScholarPubMed
6. Baroni, G, Porro, T, Faglia, E, et al. Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care. 1987;10:81–86.CrossRefGoogle ScholarPubMed
7. Cianci, P. Adjunctive hyperbaric oxygen therapy in the treatment of the diabetic foot. J Am Podiatr Med Assoc. 1994;84:448–455.Google Scholar
8. Doctor, N, Pandya, S, Supe, A. Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med. 1992;38:112–114, 111.Google ScholarPubMed
9. Eckman, MH, Greenfield, S, Mackey, WC, et al. Foot infections in diabetic patients. Decision and cost-effectiveness analyses. JAMA. 1995;273:712–720.CrossRefGoogle ScholarPubMed
10. Faglia, E, Favales, F, Aldeghi, A, et al. Changes in major amputation rate in a center dedicated to diabetic foot care during the 1980s: Prognostic determinants for major amputation. J Diabetes Complications. 1998;12:96–102.Google Scholar
11. Faglia, E, Favales, F, Aldeghi, A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care. 1996;19:1338–1343.Google Scholar
12. Gu, K, Cowie, CC, Harris, MI. Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care. 1998;21:1138–1145.Google Scholar
13. Guo, S, Counte, MA, Gillespie, KN, et al. Cost-effectiveness of adjunctive hyperbaric oxygen in the treatment of diabetic ulcers. Int J Technol Assess Health Care. 2003;19:731–737.CrossRefGoogle ScholarPubMed
14. Hailey, D, Jacobs, P, Perry, DC, et al. Adjunctive hyperbaric oxygen therapy for diabetic foot ulcer: an economic analysis. Technology Report no 75. Ottawa: Canadian Agency for Drugs and Technologies in Health; March 2007.Google Scholar
15. Kalani, M, Jörneskog, G, Naderi, N, et al. Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J Diabetes Complications. 2002;16:153–158.CrossRefGoogle ScholarPubMed
16. Medical Services Advisory Committee. Hyperbaric oxygen therapy. Medical Services Advisory Committee, editor. Canberra: Department of Health and Aged Care; 2000.Google Scholar
17. National Diabetes Surveillance Strategy. Responding to the challenge of diabetes in Canada. Ottawa: Public Health Agency of Canada, 2000.Google Scholar
18. Ohinmaa, A, Jacobs, P, Simpson, S, et al. The projection of prevalence and cost of diabetes in Canada: 2000 to 2006. Can J Diabetes. 2004;28:1–7.Google Scholar
19. Ontario Health Technology Advisory Committee. Current evaluation of hyperbaric oxygen therapy (HBOT) for chronic diabetic foot ulcers. E-Bulletin Issue 24, August 2007. Available at: http://www.health.gov.on.ca/english/providers/program/ohtac/bulletins/bul_mn.html.Google Scholar
20. Ragnarson Tennvall, G, Apelqvist, J. Health – economic consequences of diabetic foot lesions. Clin Infect Dis. 2004;39 (Suppl 2):S132–S139.CrossRefGoogle ScholarPubMed
21. Ragnarson Tennvall, G, Apelqvist, J. Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000;14:235–241.Google Scholar
22. Ramsey, SD, Newton, K, Blough, D, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22:382–387.CrossRefGoogle ScholarPubMed
23. Redekop, WK, McDonnell, J, Verboom, P, et al. The cost effectiveness of Apligraf treatment of diabetic foot ulcers. Pharmacoeconomics. 2003;21:1171–1183.CrossRefGoogle ScholarPubMed
24. Reiber, GE, Smith, DG, Carter, J, et al. A comparison of diabetic foot ulcer patients managed in VHA and non-VHA settings. J Rehabil Res Dev. 2001;38:309–317.Google ScholarPubMed
25. Simpson, SH, Corabian, P, Jacobs, P, Johnson, JA. The cost of major comorbidity in people with diabetes mellitus. CMAJ. 2003;168:1661–1667.Google ScholarPubMed
26. Zamboni, WA, Wong, HP, Stephenson, LL, Pfeifer, MA. Evaluation of hyperbaric oxygen for diabetic wounds: a prospective study. Undersea Hyperb Med. 1997;24:175–179.Google ScholarPubMed