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Why Cost-Effectiveness Matters
HBOT limb salvage costs about $33,100 per patient. A primary major amputation costs $66,300-$73,000. Over 12 years, diabetic foot ulcer patients receiving HBOT cost CND $40,695 vs. CND $49,786 for standard care, while gaining 1.73 additional quality-adjusted life years. These are the numbers driving HBOT coverage decisions, and they consistently favor treatment over amputation.
The standard metric is cost per QALY (Quality-Adjusted Life Year) gained. Interventions costing less than $50,000 per QALY are generally considered cost-effective in the US. Those under $100,000 per QALY are considered acceptable. Treatments that cost less than standard care while producing better outcomes (“dominant” strategies) represent the strongest economic case.1
Cost-Effectiveness by Indication
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.
| Study | Year | Country | Key Finding | Study Type |
|---|---|---|---|---|
| Guo et al. | 2003 | US | ICER: $27,310/QALY (yr 1) to $2,255/QALY (yr 12) | Decision model |
| Chuck et al. | 2008 | Canada | HBOT dominant: lower cost ($40,695 vs $49,786) AND better QALYs (3.64 vs 3.01) | Decision model |
| Chan | 2017 | Canada (Ontario) | Budget impact drops from $4M to $0.5M/year when downstream costs included | HTA |
| Brouwer et al. | 2024 | Netherlands | No significant overall difference; Wagner III/IV subgroup: EUR 19,005/limb saved | RCT-based |
“Over 12 years, patients receiving HBOT for diabetic foot ulcers cost CND $40,695 compared to CND $49,786 for standard care alone, while gaining 0.63 additional quality-adjusted life years.”
Chuck et al., International Journal of Technology Assessment in Health Care, 2008
HBOT vs. Amputation: Direct Cost Comparison
A 2016 US study of 159 patients with Wagner Grade 3/4 diabetic foot ulcers found that HBOT limb salvage cost approximately $33,100 per patient, compared to $66,300-$73,000 for primary major amputation. At one year, 91.7% of HBOT patients had intact lower extremities. Mortality was also lower in the HBOT group (35.4% vs. 47.2%).3
“HBOT limb salvage costs approximately $33,100 per patient, compared to $66,300-$73,000 for a primary major amputation, with 91.7% of HBOT patients retaining their limbs at one year.”
Eggert et al., Undersea & Hyperbaric Medicine, 2016
The 2024 DAMO2CLES RCT Analysis: Most Rigorous Evidence
The most methodologically rigorous analysis is from the DAMO2CLES trial (2024), which conducted economic analysis alongside an actual multicenter randomized controlled trial of 120 patients with ischaemic diabetic foot ulcers (60 HBOT, 60 standard care).4
Key findings:
- No significant overall cost difference between groups
- ICER for limb salvage: EUR 37,912 per limb saved overall
- Wagner III/IV subgroup only: EUR 19,005 per limb saved (trend toward cost-effectiveness)
- No significant QALY difference: 0.54 (HBOT) vs. 0.56 (standard care)
This is the most important finding to understand: the older decision models (Guo 2003, Chuck 2008) showed favorable economics, but they were based on assumed clinical outcomes rather than randomized data. The 2024 DAMO2CLES analysis, which used actual RCT data, found less favorable overall results. The strongest signal remains in severe wounds (Wagner III/IV).
Burns: Hospital Stay Savings
A 2026 case series from an ABA-verified burn center found that HBOT reduced hospital length of stay by an average of 5.6 days. At an estimated burn unit cost of $17,000/day, this represents approximately $92,200 saved per patient in hospitalization costs alone. Across 5 patients, total cost savings were estimated at $456,000 versus average HBOT cost of $1,000/session.5
Necrotizing Soft Tissue Infections
A 2012 analysis of 45,913 NSTI patients found significantly lower mortality with HBOT (4.5% vs. 9.4%, OR 0.49), but higher hospitalization costs ($52,205 vs. $45,464) and longer length of stay. The cost increase is offset by the mortality reduction, which carries substantial economic value when life-years are factored in.6
Medicare Cost Trends
The total Medicare cost per 40-session HBOT protocol decreased 15.6% from $27,562 in 2013 to $23,834 in 2022. Physician component costs decreased 37.8% over that same period.7
For full Medicare session pricing and coverage details, see our insurance coverage guide and CPT billing codes guide.
Limitations and Gaps in the Evidence
The fundamental challenge is that most off-label HBOT use is paid out of pocket. This prevents the large-scale claims data needed for health economic analysis. Formal cost-effectiveness models exist only for diabetic foot ulcers and, to a limited extent, radiation injuries. For TBI, long COVID, autism, and other off-label indications, cost-effectiveness data is absent rather than negative.
- Guo S, et al. “Cost-Effectiveness of Adjunctive Hyperbaric Oxygen in the Treatment of Diabetic Ulcers.” Int J Technology Assessment Health Care. 2003;19(4). PMID: 15095781.
- Chuck A, et al. “Cost-effectiveness and budget impact of adjunctive hyperbaric oxygen therapy for diabetic foot ulcers.” Int J Technology Assessment Health Care. 2008;24(2). PMID: 18400121.
- Eggert JV, Worth ER, Van Gils CC. “Cost and mortality data of a regional limb salvage and hyperbaric medicine program for Wagner Grade 3 or 4 diabetic foot ulcers.” Undersea & Hyperbaric Medicine. 2016. PMID: 27000008.
- Brouwer R, et al. “Economic analysis of hyperbaric oxygen therapy for the treatment of ischaemic diabetic foot ulcers.” Diving and Hyperbaric Medicine. 2024;54(4):265-274. PMID: 39675733.
- Shreve HA, Kopari NM, Tsutsui C. “Burn Patients with Skin Substitutes and Impact of Hyperbaric Oxygen Therapy.” Journal of Burn Care & Research. 2026. DOI: 10.1093/jbcr/irag033.248.
- Soh CR, et al. “Hyperbaric oxygen therapy in necrotising soft tissue infections.” Intensive Care Medicine. 2012;38(7). PMID: 22527074.
- Gelly HB, Fife CE, Walker D, Eckert KA. “Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022.” Undersea & Hyperbaric Medicine. 2024. PMID: 38985150.
- Chan B. Ontario Health Technology Assessment Series. 2017;17(5). PMID: 28572866.
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The content on BaricBoost.com is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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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