To determine the impact of alternative strategies for assessing eligibility for domiciliary oxygen on funded oxygen use, quality of life, and costs.
Randomized controlled trial involving applicants for a Government sponsored home oxygen program (HOP). Comparisons were an assessment system that relied on data collected and submitted by oxygen providers at the time of application and judgements by HOP personnel (conventional assessment) versus 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, with judgements by the RT and a respiratory specialist (alternative assessment). Main outcome measures included use of funded domiciliary oxygen; quality of life; mortality; costs to the health care system.
276 applicants were allocated to the conventional arm and 270 to the alternative assessment. In the year following application, oxygen use was appreciably 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.
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.
Limiting assessment of patients for eligibility for long-term oxygen to the period immediately following an exacerbation will lead to many patients receiving long-term oxygen in whom the benefit is uncertain. Many patients improve, physiologically and with respect to their quality of life, over the first three months following an exacerbation, and an appreciable additional group improve further between 3 months and one year. Optimizing oxygen use requires that the patients be reassessed, both at 3 months and at approximately one year after commencing oxygen.Table
Cost analysis comparing alternative and conventional assessment process, by type of health care expense, Canadian costing.Alternative AssessmentConventional AssessmentDifferenceAssessment and Appeal Costs$168$13$155 •HOP Coordinatorn/a4 •Respirologist20n/a •Resp. Therapist126n/a •Secretary<1n/a •Travel Blood Gas6n/a169HOP Oxygen Costs$2,501$3,097($596) 95% CI (-903,-291) p=0.0002Health Care Follow-up Costs$2,958$2,871$87 •Hospitalizations2090215895% CI •GP visits263273(-1477, 1651) •Specialist Visits136118p=0.94 •Emergency Room4436 •Clinic Visits105 •Tests/procedures193121 •Other Professionals222160Total Cost$5,627$5,982($355) 95% CI (-1968, 1259) p=.66
Mika Nonoyama, None.