Controlled CMS Data Demonstrates a Cost and Clinical Advantage for Hyperbaric Oxygen for Radiation Cystitis.

INTRODUCTION

Increasing cancer survivorship, in part due to new radiation treatments, has created a larger population at risk for delayed complications of treatment. Radiation cystitis continues to occur despite targeted radiation techniques.

MATERIALS AND METHODS

To investigate value-based care applying hyperbaric oxygen (HBO) to treat delayed radiation cystitis, we reviewed public-access Medicare data from 3,309 patients from Oct 1, 2014, through Dec 31, 2019. Using novel statistical modeling, we compared cost and clinical effectiveness in a hyperbaric oxygen group to a control group receiving conventional therapies.

RESULTS

Treatment in the hyperbaric group provided a 36% reduction in urinary bleeding, a 78% reduced frequency of blood transfusion for hematuria, a 31% reduction in endoscopic procedures, and fewer hospitalizations when study patients were compared to control. There was a 53% reduction in mortality and reduced unadjusted Medicare costs of $5,059 per patient within the first year after completion of HBO treatment per patient. When at least 40 treatments were provided, cost savings per patient increased to $11,548 for the HBO study group compared to the control group. This represents a 37% reduction in Medicare spending for the HBO-treated group. We also validate a dose-response curve effect with a complete course of 40 or more HBO treatments having better clinical outcomes than those treated with fewer treatments.

CONCLUSION

These data support previous studies that demonstrate clinical benefits now with cost- effectiveness when adjunctive HBO treatments are added to routine interventions. The methodology provides a comparative group selected without bias. It also provides validation of statistical modeling techniques that may be valuable in future analysis, complementary to more traditional methods.