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

Abstract

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 (HBO₂) 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 HBO₂ treatment per patient. When at least 40 treatments were provided, cost savings per patient increased to $11,548 for the HBO₂ study group compared to the control group. This represents a 37% reduction in Medicare spending for the HBO₂-treated group. We also validate a dose-response curve effect with a complete course of 40 or more HBO₂ 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 HBO₂ 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.