HBOT Cost vs Outcomes: Cost-Per-QALY Data Across 8 Conditions (2026)

HBOT limb salvage for a severe diabetic foot ulcer costs about $33,100 per patient. A primary major amputation costs $66,300 to $73,000. Over 12 years, a Canadian model found diabetic foot ulcer patients treated with HBOT cost less than standard care (CAD $40,695 vs $49,786) while gaining 0.63 additional quality-adjusted life years. These are the numbers behind HBOT coverage decisions, and for severe wounds they favor treatment over amputation. Session and package prices sit in our hyperbaric chamber cost guide.

Is HBOT cost-effective by condition?

Formal cost-effectiveness models exist for only a few indications, and the answer varies by wound severity. Diabetic foot ulcers carry the strongest evidence. For most off-label uses, the economic data is absent rather than negative.

Diabetic Foot Ulcers: The Best Evidence

HBOT for diabetic foot ulcers has the strongest cost-effectiveness evidence of any indication because it prevents amputation, which is catastrophically expensive downstream. The picture has also matured: early decision models were more favorable than the later randomized data.

The Chuck 2008 model is the strongest single result: over 12 years, patients treated with HBOT cost less (CAD $40,695 vs $49,786) and gained more quality-adjusted life years (3.64 vs 3.01, a 0.63 QALY difference), making HBOT a dominant strategy in that model.² The condition-specific outcome data behind these models is broken out in our diabetic foot ulcer clinical data.

How does HBOT compare to amputation on cost?

A 2016 US study of 159 patients with Wagner Grade 3 or 4 diabetic foot ulcers found that the HBOT limb salvage protocol cost about $33,100 per patient, versus $66,300 to $73,000 for primary major amputation. At one year, 91.7% of the salvage-protocol patients had intact lower extremities.³

What did the DAMO2CLES RCT find?

The most methodologically rigorous analysis comes from the DAMO2CLES trial, whose economic evaluation ran alongside a multicenter randomized controlled trial of patients with ischaemic diabetic foot ulcers.⁴ Key findings:

• No significant overall cost difference between groups
• Overall ICER for limb salvage: EUR 37,912 per limb saved
• Wagner III/IV subgroup only: EUR 19,005 per limb saved (trend toward cost-effectiveness)
• No significant QALY difference overall

This is the finding to internalize: the older decision models (Guo 2003, Chuck 2008) assumed clinical outcomes, while the 2024 DAMO2CLES analysis used actual randomized data and found less favorable overall economics. The clearest benefit concentrates in severe wounds (Wagner III/IV), which matches the clinical picture.

Burns: does HBOT reduce hospital costs?

The economic case for burns is emerging rather than settled. A 2026 systematic review in the Journal of Burn Care & Research synthesized 13 studies (5 RCTs, 7 cohorts, 1 case-control) covering 566 burn patients and reported trends toward reduced need for surgery and shorter hospital stays with adjunctive HBOT, while mortality benefits were inconsistent and study designs too heterogeneous to pool.⁵ Shorter length of stay is where the savings would come from, given burn-unit day costs, but the trial base is not yet large or uniform enough to produce a reliable cost-per-QALY figure.

Necrotizing Soft Tissue Infections

A 2012 analysis of the US Nationwide Inpatient Sample identified 45,913 patients with necrotizing soft tissue infections, of whom 405 received HBOT. The HBOT group had significantly lower mortality (4.5% vs 9.4%, adjusted odds ratio 0.49) despite higher hospitalization costs and longer stays.⁶ The added cost is offset by the mortality reduction, which carries substantial economic value once life-years are counted.

How much does Medicare pay for HBOT?

A 2024 analysis of Hyperbaric Oxygen Therapy Registry data from 53 centers estimated the Medicare cost of HBOT (outpatient facility plus physician fees) across 2013 to 2022 and found the estimated cost of a standard 40-treatment series declined over the decade, with the physician-fee component falling most steeply.⁷ The trend reflects reimbursement changes rather than fewer treatments per patient.

For full Medicare session pricing and coverage details, see our insurance coverage guide and CPT billing codes guide.

Where is the evidence missing?

The fundamental challenge is that most off-label HBOT is paid out of pocket, which prevents the large-scale claims data that health economic analysis needs. Formal cost-effectiveness models exist only for diabetic foot ulcers and, to a limited extent, radiation injury and necrotizing infections. For TBI, long COVID, autism, and other off-label indications, cost-effectiveness data is absent rather than negative. Absence of an economic model is not evidence that a therapy fails; it means the study has not been funded.

Seph Fontane Pennock

Author

Seph Fontane Pennock is the founder of BaricBoost.com and Regenerated.com, a clinic directory for regenerative medicine serving 10,000+ providers across the United States. He previously built and sold PositivePsychology.com, which grew to 19 million users and became the largest evidence-based positive psychology resource on the web. Seph brings direct experience as an HBOT patient, having completed protocols at clinics across three continents while navigating mold illness, systemic inflammation, and autoimmune conditions. His treatment journey includes hyperbaric oxygen therapy, peptide protocols, NAD+ therapy, and consultations with specialists from Dubai to Cape Town to Mexico. This combination of entrepreneurial track record and lived patient experience shapes everything published on BaricBoost.com. Every article is grounded in peer-reviewed research, informed by real clinical encounters, and written for patients making high-stakes treatment decisions. Seph's focus is on bringing transparency, scientific rigor, and practical guidance to the hyperbaric oxygen therapy space.

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