Authors' objectives:

The objectives of this report are the following: 1) to summarize published data about a) the effectiveness and use of portable oxygen therapy in the treatment of patients with chronic obstructive pulmonary disease (COPD) associated with severe hypoxaemia, b) different health-care organization models, and c) the cost effectiveness and quality of the care provided to these patients; and to review the psychosocial, legal and ethical implications involved in the delivery of oxygen therapy services; 2) to present a broad outline of service delivery in Quebec with respect to the different types of oxygen systems available and the questions they raise; 3) to present a comparative analysis of the two home-oxygen programs in Canada that have adopted long-term oxygen therapy (LTOT) organization and service-delivery models known to be efficient and effective (Ontario and Alberta); and 4) to draw conclusions and make recommendations serving to guide the development of policies and practices, and to direct research in Quebec.

Authors' recommendations: While it has been clearly shown that the use of LTOT prolongs the lives of patients with COPD, there is limited published evidence regarding the costs and benefits of portable oxygen therapy. Oxygen therapy (with pharmacotherapy) is one of the largest cost components in the management of severe COPD with hypoxaemia, and portable oxygen therapy is commonly considered an expensive part of LTOT even though there is little information on its actual marginal costs. Whereas the criteria for prescribing LTOT are almost universally accepted, none exist for portable oxygen therapy. The United States x and the United Kingdom, however, have adopted some guidelines. The very first controlled trial to assess the costs and benefits of portable oxygen therapy was conducted at Hopital Laval in Quebec and completed in the fall of 2003. Preliminary results seem to indicate that portable oxygen equipment does not improve patients' quality of life, compliance with treatment or exercise tolerance. The researchers conclude that portable oxygen therapy should not be prescribed routinely to all oxygen-dependent patients with COPD. Nevertheless, it is doubtful whether these findings can be generalized to all patients, given that the sample size was very small (n=22) and that the researchers had difficulty recruiting patients for this trial. In Quebec, the organization and delivery of home oxygen therapy has varied significantly from one region to the next since 1998 when the services offered by the Office des personnes handicapees du Quebec (OPHQ) were decentralized. These services are now provided at various levels. Some are regionally centralized, while others are based at a hospital or CLSC, when they are not subcontracted outright to oxygen-equipment suppliers. No data have ever been systematically gathered on the use, cost, health outcomes or quality of care, permitting an analysis of the delivery of home oxygen therapy services. Reported use of portable oxygen therapy also varies widely, but there are no precise figures available. Coverage of portable systems is complex and inconsistent across the province. Most patients with COPD who are eligible for longterm oxygen therapy do not have private insurance.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/fr/publications/scientifiques/pneumologie/2 004_03_en.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)