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Hyperbaric oxygen for MS: update

Review
Results
Comment
Bandolier 62 explored evidence about the effectiveness of hyperbaric oxygen therapy for multiple sclerosis, and found it to be profoundly negative. A new review [1] examines the subject in a wider context and comes to a similar conclusion, but adds an economic assessment suggesting that even if it were effective, the cost for one successfully treated patient would be over £600,000.

Review


The formal search for this review included five electronic databases, including a specialised multiple sclerosis registry from the Cochrane Collaboration and a specialised register for hyperbaric medicine, as well as manual searches of hyperbaric journals, proceedings and texts since 1980. In assessing the evidence, it examined reviews, randomised trials, non-randomised studies and case series.

Results


The main findings of the new review can be summarised thus:


The authors of the review make the point that all of these studies are likely to have some degree of bias in favour of hyperbaric oxygen. The only patients with long-term assessments were those who continued treatments over several years, and many of those dropping out of the trials were likely to be patients finding no improvement.

The impact of hyperbaric oxygen is unlikely to be great. While there is no statistically significant improvement in either symptom improvement or improvement of sphincter function, the best estimates for numbers needed to treat were 42 and 25 respectively, with confidence intervals that include infinity.

Based on the need for 68 treatments in the first year, and a cost of US$300 per treatment, the best estimate for the cost of one patient benefiting from improved symptoms would be US$860,000 (or Euros), or £612,000, but with a range of about $300,000 to infinite cost.

Comment


This will be a most useful position paper for purchasers because it puts hyperbaric oxygen therapy into a perspective including other treatments and their costs. It is also the official position of the Undersea and Hyperbaric Medical Society.

The methodological take-home message, again, is that observational studies show benefit while proper randomised studies do not. We must not forget this lesson.

Reference:

  1. M Bennett, R Heard. Treatment of multiple sclerosis with hyperbaric oxygen therapy. Undersea and Hyperbaric Medicine 2001 28: 117-122.
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