A RANDOMIZED TRIAL OF STRATEGIES FOR ASSESSING ELIGIBILITY FOR LONG-TERM DOMICILIARY OXYGEN THERAPY

Abstract

Rationale: Restricting oxygen administration to those who benefit isdesirable.Objective:To determinethe impactof alternativestrategies for assessing eligibility for domiciliary oxygen on funded oxygen use, quality of life, and costs. Methods: We randomized applicants for domiciliary oxygen therapy to an assessment system that relied on data collected by oxygen providers at the time of application and judgments by Home Oxygen Program personnel (conventional assessment) or to a system of data collection by a respiratory therapist that included, in patients unstable at the time of initial assessment, a repeat assessment after 2 months of stability (alternative assessment). Measurements and Main Results: A total of 276 applicantswereallocatedtotheconventionalarmand270tothealternative assessment. In the year after application, oxygen use was lower inthe alternativearm withno between-groupdifferences inmortality, 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 Home Oxygen Program costs of $596 per applicant using Canadian cost weights. The comparable U.S. dollar figures were $309 and $432, respectively, and the difference in cost between strategies was therefore smaller using U.S. cost weights.