Vol 75, No 1 (2024)
Review article
Published online: 2024-03-29

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Cost-effectiveness analysis of adjunctive hyperbaric oxygenations in diabetic feet ulcer: a systematic review

Ana Khusnul Faizah12, Tri Murti Andayani1, Libriansyah 3, Dwi Endarti1
DOI: 10.5603/imh.98770
IMH 2024;75(1):35-42.


Background: Hyperbaric oxygen therapy (HBOT) has been reported to be beneficial in enhancing wound
healing and preventing amputations in diabetic foot ulcers (DFU), though not many studies are available
to demonstrate how cost-effective this treatment is. A comprehensive assessment of cost-effectiveness
evaluations about hyperbaric oxygen therapy (HBOT) considering financial viability into account is critical
and essential.

Objective: To assess the cost-effectiveness of HBOT in DFU patients.

Materials and methods: A systematic search (October 2023) was performed in 3 databases: PUBMED,
EMBASE, and Cochrane CENTRAL. The study was guided by the PICO research question as detailed (Population:
DFU patients; Intervention: HBOT; Comparison: standard care; Outcome: ICER). Cost-effectiveness
analyses (CEAs) involving interventions in DFU patients with Wagner III and above were included. The main
outcomes of this review were costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness
ratio (ICER). The CHEERS checklist was used to assess the quality of CEAs.

Results: Two studies revealed the cost-effectiveness of standard wound care (SWC) plus HBOT, whereas
one study showed that HBOT was not cost-effective as adjunctive treatment for DFU. The ICER of HBOT
in 12 years were $2,255/QALY and US$2621/QALY.

Conclusion: The evidence to support the cost-effectiveness of HBOT is insufficient. However, the majority
of HBOT studies have reported this therapy was cost-effective. Instead of model-based evaluations,
further studies should combine clinical application of interventions with concomitant economic assessment.

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