Is HBOT Cost-Effective For Diabetic Foot Ulcers?
- Volume 22 - Issue 6 - June 2009
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Transcutaneous oximetry has been suggested as one way of enhancing patient selection. An evidence-based approach to the use of transcutaneous oximetry is in press.16 The first step is to assess whether wounds are likely to heal spontaneously by using baseline TcPO2.17After vascular status has been optimized, repeat transcutaneous oximetry can assist in determining whether healing is likely.
It may be possible to determine the benefit of HBOT using in-chamber TcPO2. In-chamber values of 200 mmHg or better among patients with diabetes are associated with a high likelihood of benefit from HBOT. However, a trial of HBOT may still be appropriate even in patients with low in-chamber values since the predictive value of TcPO2 is less than 70 percent.12 Retrospective data suggest that among patients who benefited from HBOT, the average number of treatments was 36. One should discontinue treatments as soon as continued healing seems likely.
Data confirm that many wounds remain hypoxic even after revascularization. Healing will not occur unless one corrects the hypoxia. Among all modalities tested over the past 10 years, the currently available research has demonstrated that only HBOT corrects tissue hypoxia.
Studies confirm that HBOT reduces the rate of major amputation and increases quality of life years when one ensures proper patient selection. Given the low likelihood of rehabilitation after a major amputation and the high morbidity and mortality, it is not difficult to demonstrate the cost-effectiveness of HBOT in appropriately selected patients.
In Britain, the National Institute for Health and Clinical Excellence (NICE) has concluded that $45,000 is the maximum amount they will pay to increase a life by one “quality-adjusted” year.
The U.S. government has recently embraced creation of similar “comparative effectiveness” research, carving out $1.1 billion from H.R. 598, the $825 billion economic stimulus bill. Accompanying report language says “more expensive” medical products “will no longer be prescribed.” The bill will create a “federal health board” to rate medical products and create central controls on access. Where shall we set the bar on the cost of quality-adjusted life years?
Dr. Fife is an Associate Professor in the Department of Medicine within the Division of Cardiology at the University of Texas Health Science Center in Houston. She is the Director of Clinical Research at the Memorial Hermann Center for Wound Healing and Hyperbaric Medicine.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons
For further reading, see “Is There A Role For HBO In Limb Salvage?” in the August 2008 issue of Podiatry Today, “A Guide To Hyperbaric Oxygen Therapy For Diabetic Foot Wounds” in the December 2007 issue or “What You Should Know About Using HBO In Diabetic Wounds” in the May 2003 issue.
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