The clinical and cost effectiveness of hyperbaric oxygen
therapy (HBOT)
About this systematic review
A review of the range of conditions for which hyperbaric
oxygen therapy (HBOT) should be used was commissioned following
discussion among the UK Public Health Specialist Commissioner Group
regarding National Health Service (NHS) provision of the
intervention.
This review was based on a horizon scanning report produced by
the Agency for Healthcare Research and Quality (AHRQ), USA and
attempted to identify all indications for which HBOT has been
suggested as an appropriate intervention. Literature searches for
reports on the clinical and/or cost effectiveness of HBOT were
conducted to identify primary and secondary literature, for the
period from 2005 (when the AHRQ report was published) to July 2007.
Paediatric studies and reports published in languages other than
English were excluded from literature searches. Reports considering
the safety of HBOT were included.
Background
Hyperbaric chambers have been used to treat the effects of
decompression illness since the nineteenth century, with HBOT being
introduced for the condition in the early twentieth century. HBOT
has subsequently been utilised for the treatment of a wide range of
medical conditions for which the theoretical basis and/or the
evidence of effectiveness is not convincing. The United Kingdom
(UK) Department of Health and a number of professional groups have
provided guidance on conditions for which they consider HBOT to be
appropriate standard care or adjunctive therapy.
Results and conclusions
The only indication for which there was a body of
cost-effective evidence was diabetic foot ulcer. For many
conditions there may be some evidence of effectiveness but this has
been derived from case series or clinical trials that were poorly
conducted or reported, and therefore cannot be considered robust.
In these cases, a well-designed RCT may help to provide definitive
evidence.
For some conditions there was a reasonable body of clinical
effectiveness evidence but the findings conflicted. Again, a
well-designed large RCT may provide better data. A number of RCTs
are currently underway.
For decompression illness and CO poisoning, HBOT use is
supported by a good theoretical basis, long-standing use and
clinical consensus, despite a lack of RCT evidence. It would be
difficult to justify further trials in these treatment areas.
A summary of the full findings is presented in Table 7.5-1 of
the report.
Further information
For further information, or to receive a copy of the published
report, please contact Doreen Pedlar at
Doreen.Pedlar@nhs.net.
Published Date: default
