Published ahead of print on May 18, 2005, doi:10.1164/rccm.200412-1692OC Am. J. Respir. Crit. Care Med., Volume 172, Number 5, September 2005, 573-580 A more recent version of this article appeared on September 1, 2005
Submitted on December 16, 2004 A Randomized Trial of Strategies for Assessing Eligibility for Long-Term Domiciliary Oxygen TherapyGordon H Guyatt1*,1 Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, 2 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada, 3 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, 4 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Program for Assessment of Technology in Health (PATH), St. Joseph's Healthcare, Hamilton, Ontario, Canada, 5 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada, 6 Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada * To whom correspondence should be addressed. E-mail: guyatt{at}mcmaster.ca.
Rationale: Restricting oxygen administration to those who benefit is desirable. Objective: To determine the impact of alternative strategies for assessing eligibility for domiciliary oxygen on funded oxygen use, quality of life, and costs. Methods: We randomized applicants for domiciliary oxygen therapy to an assessment system that relied on data collected by oxygen providers at the time of application and judgments by home oxygen program (HOP)personnel (conventional assessment) to a system of data collection by a respiratory therapist that included in patients unstable at the time of initial assessment, a repeat assessment after two months of stability (alternative assessment). Measurements and Main Results: 276 applicants were allocated to the conventional arm and 270 to the alternative assessment. In the year following application, oxygen use was lower in the alternative arm with no between group differences in mortality, quality of life or resource use in the community. Although alternative assessment applicants had on average higher assessment costs by $155 per applicant, these costs were more than offset by decreased HOP costs of $596 per applicant using Canadian cost weights. The comparable American dollar figures were $309 and $432 respectively, and the difference in cost between strategies was therefore smaller using American cost weights. Conclusions: Reassessment of applicants for domiciliary oxygen after several months of stability identifies an appreciable portion of initially eligible patients who are no longer eligible, thus reducing program costs to public funders without adverse consequences on quality of life, mortality, or other resource use. Key words: domiciliary oxygen, stability, economic benefits
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