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COST-EFFECTIVENESS OF ADJUNCTIVE HYPERBARIC OXYGEN IN THE TREATMENT OF DIABETIC ULCERS

Published online by Cambridge University Press:  21 April 2004

Shien Guo ,
Michael A. Counte ,
Kathleen N. Gillespie  and
Homer Schmitz
Shien Guo
Affiliation:
Saint Louis University
Michael A. Counte
Affiliation:
Saint Louis University
Kathleen N. Gillespie
Affiliation:
Saint Louis University
Homer Schmitz
Affiliation:
Saint Louis University
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Abstract

Objectives: This study estimates the cost-effectiveness (CE) of the adjunctive use of hyperbaric oxygen (HBO2) therapy in the treatment of diabetic ulcers based on the payer's and societal perspectives.

Methods: The study population was a hypothetical cohort of 1,000 patients sixty years of age with severe diabetic foot ulcers. A decision tree model was constructed to estimate the CE of HBO2 therapy in the treatment of diabetic ulcers at years 1, 5, and 12. Scenario and one-way sensitivity analyses were also undertaken to identify parameters that may significantly influence the estimates.

Results: The CE model estimated that the incremental cost per additional quality-adjusted life year (QALY) gained at years 1, 5, and 12, was $27,310, $5,166, and $2,255, respectively.

Conclusions: The study results indicate that HBO2 therapy in the treatment of diabetic ulcers is cost-effective, particularly based on a long-term perspective. However, the results are limited by the clinical studies that provide the basis of the CE estimation.

Keywords

Hyperbaric oxygenDiabetic ulcersCost-effectivenessTechnology assessment
Type
RESEARCH NOTES
Information
International Journal of Technology Assessment in Health Care , Volume 19 , Issue 4 , December 2003 , pp. 731 - 737
Copyright
© 2004 Cambridge University Press

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References

Arias E. 2000 United States life table, Center for Disease Control. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_03.pdf. Accessed February 11, 2003.
Baroni G, Porro T, Faglia E et al. 1987 Hyperbaric oxygen in diabetic gangrene treatment. Diabetes Care. 10: 81- 86.Google Scholar
Blid DE, Stevenson JM. 1992 Frequency of recording of diabetes on U.S. death certificates: Analysis of the 1986 National Mortality Followback Survey. J Clin Epidemiol. 45: 275- 281.Google Scholar
Braddeley RM, Fulford JC. 1965 A trial of conservative amputations for lesions of the feet in diabetes mellitus. Br J Surg. 52: 38- 43.Google Scholar
Cianci P. 1994 Adjunctive hyperbaric oxygen therapy in the treatment of the diabetic foot. J Am Podiatr Med Assoc. 84: 448- 455.Google Scholar
Cianci P, Hunt T. 2001 Adjunctive hyperbaric oxygen therapy in the treatment of the diabetic foot wound. In: Bowker J, Pfeifer M, eds. Levin and O'Neal's the diabetic foot. St. Louis: Mosby; 404- 421.
Ciaravino ME, Friedell ML, Kammerlocher TC. 1996 Is hyperbaric oxygen a useful adjunct in the management of problem lower extremity wounds? Ann Vasc Surg. 10: 558- 562.Google Scholar
Doctor N, Pandya S, Supe A. 1992 Hyperbaric oxygen therapy in diabetic foot. J Postgrad Med. 38: 112- 114.Google Scholar
Drummond MF, O'Brien B, Stoddart GL, Torrance GW. 1997 Methods for the economic evaluation of health care programs. New York: Oxford University Press
Eckman MH, Greenfield S, Mackey W et al. 1995 Foot infections in diabetic patients: Decision and cost-effectiveness analyses. JAMA. 273: 712- 720.Google Scholar
Faglia E, Favales F, Aldeghi A et al. 1996 Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care. 19: 1338- 1343.Google Scholar
Garber AM, Phelps CE. 1997 Economic foundations of cost-effectiveness analysis. J Health Econ. 16: 1- 31.Google Scholar
Gold MR, Siegel J, Russell LB, Weinstein MC. 1996 Cost-effectiveness in health and medicine. New York: Oxford University Press
Gu K, Cowie CC, Harris MI. 1998 Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care. 21: 1138- 1145.Google Scholar
Hammarlund C, Sundberg T. 1994 Hyperbaric oxygen reduced size of chronic leg ulcers: A randomized double-blind study. Plast Reconstr Surg. 93: 829- 833.Google Scholar
Hyperbaric Oxygen Therapy Association. The costs of hyperbaric oxygen therapy prepared by The Lewin Group. Available at: http://www.uhms.org/legislation/lewin.htm. Accessed June 20, 2002.
Lee SS, Chen CY, Chan YS et al. 1997 Hyperbaric oxygen in the treatment of diabetic foot. Chang Geng Med J. 20: 17- 22.Google Scholar
Ollendorf D, Kotsanos J, Wishner W et al. 1998 Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. Diabetes Care. 21: 1240- 1245.Google Scholar
Oriani G, Meazza D, Favales F et al. 1990 Hyperbaric oxygen therapy in diabetic gangrene. J Hyperb Med. 5: 171- 174.Google Scholar
Oriani G, Michael M, Meazza D et al. 1992 Diabetic foot and hyperbaric oxygen therapy: A ten-year experience. J Hyperb Med. 7: 213- 221.Google Scholar
Plafki C, Peters P, Almeling M et al. 2000 Complications and side effects of hyperbaric oxygen therapy. Aviat Space Environ Med. 71: 119- 124.Google Scholar
Ragnarson-Tennvall G, Apelqvist J. 2000 Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 14: 235- 241.Google Scholar
Ramsey SD, Newton K, Blough D et al. 1999 Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 22: 382- 387.Google Scholar
Reiber GE. 2001 Epidemiology of foot ulcers and amputation in the diabetic foot. In: Bowker J, Pfeifer M, eds. Levin and O'Neal's the diabetic foot. St. Louis: Mosby; 13- 32.
Reiber GE, Lipsky BA, Gibbons GW. 1998 The burden of diabetic foot ulcers. Am J Surg. 176: 5s- 10s.Google Scholar
Wattel F, Mathieu D, Coget JM, Billard V. 1990 Hyperbaric oxygen therapy in chronic vascular wound management. Angiology. 41: 59- 65.Google Scholar
Willians RL, Armstrong DG. 1998 Wound healing. Clin Podiatr Med Surg. 15: 117- 128.Google Scholar
Wunderlich RP, Peters EJG, Lavery LA. 2000 Systemic hyperbaric oxygen therapy: Lower-extremity wound healing and the diabetic foot. Diabetes Care. 23: 1551- 1555.Google Scholar
Zamboni WA, Wong HP, Stephenson LL, Pfeifer MA. 1997 Evaluation of hyperbaric oxygen for diabetic wounds: A prospective study. Undersea Hyperb Med. 24: 175- 179.Google Scholar