| Stage 3 - Formulation of Advice to the Minister | This assessment was considered by the MSAC at the 16 August 2000 meeting.
The MSAC recommended that public funding should be supported for HBOT administered in either a multiplace or monoplace chamber, as appropriate, for the following indications:
- decompression illness, gas gangrene, air or gas embolism. HBOT is widely accepted as standard clinical care in the management of these life-threatening conditions for which there are limited alternative treatment options;
- diabetic wounds including diabetic gangrene and diabetic foot ulcers. There is evidence that HBOT is effective in promoting wound healing, and reducing the length of hospital stays and the likelihood of major amputations in patients with diabetic wounds. There may also be cost savings associated with these treatment benefits; and,
- necrotising soft tissue infections including necrotising fasciitis and Fournier's gangrene and the prevention and treatment of osteoradionecrosis. These are serious conditions in which HBOT provides a non-invasive treatment option which may have a beneficial effect and offer cost-savings. Further studies are required to provide more conclusive evidence of an effect but are difficult to undertake due to the ethical and practical constraints of conducting trails in these conditions.
Public funding should be continued for HBOT use in these conditions until conclusive evidence becomes available that indicates it is not effective or that other treatments are preferable and more cost-effective.
Since there is currently insufficient evidence pertaining to HBOT use in the following indications, the MSAC recommended that public funding should not be supported for HBOT administered in either a multiplace or monoplace chamber, for;
- thermal burns, non-diabetic wounds and decubitus (or pressure) ulcers, necrotising arachnidism, actinomycosis, soft tissue radionecrosis, osteomyelitis, skin graft survival, multiple sclerosis and cerebral palsy, cardiovascular conditions including acute myocardial infarctions, cerebrovascular disease, and peripheral obstructive arterial disease, soft tissue injuries including acute ankle sprains and crush injuries, facial paralysis (Bell's palsy), cluster and migrane headaches, Legg-Calves-Perthes disease, sudden deafness and acoustic trauma, Crohn's disease, osteoporosis, cancer, carbon monoxide poisoning, cyanide poisoning, head trauma, cerebral oedema, acquired brain injury, cognitive impairment, senile dementia, glaucoma, keratoendotheliosis, HIV infection, anaemia from exceptional blood loss, insulin-dependent diabetes mellitus, facial neuritis, arthritis, spinal injuries and non-union of fractures.
The MSAC has not considered saftey standards for HBOT services administered in either multiplace or monoplace chambers, in detail, but endorses a standard for facilities, staffing and training which meets that in development by Standards Australia. |
