Cost-effectiveness of long-term oxygen therapy for chronic obstructive disease.

ABSTRACT

OBJECTIVES: To assess the cost-effectiveness of long-term oxygen therapy to facilitate proper resource allocation. STUDY DESIGN: Markov process. METHODS: A Markov model was developed to estimate the incremental cost-effectiveness ratios (ICERs) for continuous and nocturnal oxygen therapies. The maximum time horizon was set to 5 years. Efficacy variables were obtained from pertinent clinical studies. Cost variables were based on the current Medicare reimbursement rate and on appropriate sources. Multiple 1-way and probabilistic sensitivity analyses were performed to examine the robustness of base-case results. RESULTS: The ICER for continuous oxygen therapy ($16,124 per quality-adjusted life-year [QALY]) was within bounds considered to be cost-effective, while that of nocturnal oxygen therapy was not ($306,356/QALY). The estimated ICER for continuous oxygen therapy was robust (95% confidence interval, $13,153-$24,658/QALY) and was more favorable than the ICERs for commonly used medical and surgical therapies for chronic obstructive pulmonary disease. The ICER for nocturnal oxygen therapy was sensitive to variation in the mortality rate; it could be as low as $18,267/QALY gained. At the other end, nocturnal oxygen therapy could be less effective than no oxygen therapy, despite additional costs. CONCLUSIONS: There is substantial room for improvement in the current Medicare policies regarding long-term oxygen therapy. Medicare coverage can be improved by prescribing long-term oxygen therapy to patients who will receive substantial benefit and by providing adequate support for services and maintenance.