Hyperbaric oxygen therapy for osteonecrosis assessed in Norway

In early 2019, the Norwegian Institute of Public Health (NIPH) has published a health technology assessment report regarding hyperbaric oxygen therapy (HBOT) for osteonecrosis. For now, the total incidence of this disease in Norway is unknown, but osteonecrosis was the primary cause of 226 of almost 9000 primary hip prosthesis surgeries in 2016. The assessment was conducted since the Norwegian health service has no clear guidelines for treatment strategies at the early stages of osteonecrosis. The report contains a systematic review of clinical efficacy, safety, and cost-effectiveness of HBOT for osteonecrosis.

The NIPH provided the following conclusions:

• The evidence is too ambiguous to answer the question of the efficacy and safety of HBOT for other outcomes and in the case of other types of osteonecrosis. Thus, it remains unknown whether HBOT in addition to standard treatment gives better, poorer or identical effects on any of the outcomes, compared to other or no treatment
• The economic evidence about the use of HBOT for osteonecrosis is very limited. The search was constrained to a very simplified cost-effectiveness model because of insufficient information about the natural history of the disease and quality of life among patients. The model can only be used to calculate the cost per additional patient who achieves complete mucosal coverage but not to calculate the cost per QALY for patients receiving HBOT. Without a calculation of the cost per QALY, it is not possible to assess the severity of the disease or to measure cost-effectiveness in a way that is easily comparable across other types of treatments or diseases
• HBOT for radiation-related osteonecrosis can lead to more patients achieving complete mucosal coverage of the jawbone than with standard therapy. For these patients HBOT could potentially be interpreted as cost-effective if the willingness-to-pay for an additional patient who achieves complete mucosal coverage of the jaw is more than approximately NOK 341,000;
• In order to provide better research-based answers to questions about the effect of HBOT, the authors recommend future studies to be based on controlled, prospective study design and include relevant clinical outcomes, study populations of adequate size, and opportunities for long-term follow-up. Children should also be involved in the studies.

See the main results of the assessments in Norwegian and English here.

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