As anyone knows who has treated a patient with late effects of radiation to the bladder, the impact of HBO2 can be dramatic in terms of improving life-altering symptoms like radiation cystitis which causes bleeding and pain with urination. Some patients can bleed so much from the bladder that they require blood transfusions. I have treated patients whose cystitis was so severe that we put them in the hyperbaric chamber with a unit of blood running into their arm via an IV, and so much blood coming out of their bladder from a urinary catheter that the urine collection bag looked like the transfusion bag. HBO2 managed to stop the bleeding in such patients and save them from requiring the surgical removal of their bladder.

There are no treatments other than HBO2 for patients with such severe problems. It stands to reason that HBO2 can also reduce the Medicare costs associated with radiation induced hemorrhagic cystitis. Studies looking at the economic value of HBO2 are vital to ensure that it continues to be covered by the Medicare program. A new study by authors Feldmeier, Kirby, Gelly, Robins, and Peters is available ahead of print in Undersea and Hyperbaric Medicine (UHM). The study shows that HBO2 improves outcome, reduces mortality and saves Medicare dollars among patients with radiation cystitis.

Public-access Medicare data from 3,309 patients was evaluated from Oct 1, 2014, through Dec 31, 2019. Using novel statistical modeling, the authors compared the cost and clinical effectiveness in a hyperbaric oxygen treated group to a control group receiving conventional therapies. The hyperbaric group had a 36% reduction in urinary bleeding, a 78% reduction in frequency of blood transfusion for hematuria, a 31% reduction in endoscopic procedures, and fewer hospitalizations compared to non-hyperbaric controls. The HBO2 treated group also had a 53% reduction in mortality.

HBO2 treatment reduced the unadjusted Medicare costs by $5,059 per patient within the first year after completion treatment. When at least 40 HBO2 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. Most interesting, the authors validated a dose-response curve for HBO2 showing that patients undergoing a complete course of 40 or more HBO2 treatments had better clinical outcomes than those receiving fewer treatments. These data support previous studies that demonstrate the clinical benefits and cost-effectiveness of HBO2 in conjunction with routine interventions.