Australian Government - Department of Health

Medical Services Advisory Committee (MSAC)

1054.1 - Review of Interim Funded Service: Hyperbaric Oxygen Treatment (HBOT)

Application No.

1054.1

Application NameReview of Interim Funded Service: Hyperbaric Oxygen Therapy (HBOT) for the Treatment of Chronic Non-Diabetic Wounds and Non-Neurological Soft Tissue Radiation Injuries
Description Of Intervention(1) Late Soft Tissue Radiation Injury
Late soft tissue radiation injury is a complication experienced by a minority of individuals who successfully recover from radiation treatment for cancer. It occurs when healthy adjacent tissue is damaged in the process of treating cancer with radiotherapy. The damage to healthy tissue may not become apparent for months or years after treatment. Radiotherapy technology and techniques are rapidly advancing and side effects are becoming fewer. Examples of the impact on affected individuals include: ulceration in the mouth, impairment of speech, skin ulceration with persistent non-healing painful wounds and infections in body regions that have received radiotherapy, bleeding from the bladder or bowel, or incontinence. Life-threatening infections may also result from untreated bladder or bowel radiation injury. There are limited treatment options available for this condition, and the evidence supporting all treatments is also limited.

(2) Chronic Refractory Skin Ulcers and Wounds
Chronic or refractory problem wounds are skin ulcers and wounds that persist longer than 3 months and do not respond to standard treatment. The wounds require visits to health facilities or home care visits by community healthcare workers for months or years. Complications are frequent and may require admission to hospital. The true incidence, impact and cost are difficult to assess accurately given the wide range of disease, lack of high quality scientific studies of treatments. Approximately 1% of the population of industrialised countries will experience a chronic leg wound at some time, while the prevalence in hospital patients has been estimated at 24%. Many of these wounds are associated with circulatory disorders and lack of oxygen can be a contributing factor.
Description Of DiseaseHyperbaric Oxygen Therapy (HBOT) involves placing the patient in a compression chamber, increasing the pressure within the chamber, and administering 100% oxygen for breathing. In this way, it is possible to deliver a greatly increased pressure of oxygen to the patient’s body tissues. The pressure of oxygen delivered to the patient is increased by 12 to 15 fold and oxygen is able to diffuse further into the diseased tissue. Healing is assisted by providing sufficient oxygen at a cellular level to restore normal function. This reduces swelling and also inhibits some bacteria that would otherwise thrive in a low oxygen environment. Treatments are delivered once or twice daily and typically last between 60 and 120 minutes. A typical course might involve 20 to 30 treatments, in order to heal long standing wounds or radiation injuries.
Advisory PanelProfessor John Horvath
Chair
MSAC Member (until 31/12/2010)
Dr Christine Tippett
Deputy Chair
MSAC Member
Mr Malcolm Wells
Consumer Health Forum Nominee
A/Prof David Smart
Hyperbaric Medicine specialist
Dr Liz Kenny
Oncologist
A/Prof Michael Bennett
Hyperbaric Medicine specialist
A/Prof Michael Leung
Plastic & Reconstructive Surgeon
Date Received by MSAC Secretariat4 February 2010
Stage 1 - Eligibility23 February 2010
Stage 2 - Assessment Associate Professors David Smart and Michael Bennett of the 1054.1 Advisory Panel did not agree that their views were reflected in the final MSAC Assessment Report: Review of Interim Funded Service: Hyperbaric Oxygen Therapy (HBOT) for the Treatment of Chronic Non-Diabetic Wounds and Non-Neurological Soft Tissue Radiation Injuries.
The statement of their dissent is that the analysis of clinical outcomes and cost for Hyperbaric Oxygen treatment on non-diabetic problem wounds was flawed, in that an incorrect clinical pathway was used and the results of a prospective multicentre national study of Hyperbaric Oxygen treatment of non-diabetic wounds, was dismissed by MSAC.
Stage 3 - Formulation of Advice to the MinisterAfter considering the strength of the available evidence in relation to the safety, effectiveness and cost-effectiveness of Hyperbaric Oxygen Therapy for the treatment of localised non-neurological soft tissue radiation injuries (that have not responded to usual treatments), excluding lymphoedema following breast cancer, MSAC supports continued public funding for HBOT for this indication.

After considering the strength of the available evidence in relation to the safety, effectiveness and cost-effectiveness of Hyperbaric Oxygen Therapy for the treatment of chronic non-diabetic wounds MSAC does not support public funding for this indication on the basis of insufficient evidence
Stage 4 - DecisionESC considered this assessment on 12 and 13 October 2011.
MSAC appraised this assessment on 29 November 2011.
The Minister noted MSAC's advice 30 April 2012.

MSAC consideration 2 August 2012
Public Summary Document - PDF
Public Summary Document - Accessible word doc
Stage 5 - ImplementationIn Progress