Economic evaluation of long-term oxygen therapy: 24 hours versus 15 hours per day in severe hypoxemia—the REDOX trial

RATIONALE: Long-term oxygen therapy (LTOT) given for at least 15 hours/day improves survival in patients with severe chronic hypoxemia. However, the recent REDOX trial showed that LTOT prescribed for 24 hours/day was not superior to 15 hours/day in terms of death, hospitalizations, or self-reported outcomes. OBJECTIVES: We aimed to examine the cost effectiveness of prescribing LTOT for 24 versus 15 hours/day. METHODS: A cost minimization analysis of the REDOX trial data on 241 patients with severe hypoxemic respiratory failure randomized 1:1 to either LTOT 24 hours/day (n = 117) or 15 hours/day (n = 124) and followed up to 12 months. Data on medical care consumption including prescribed medication costs, specialized outpatient care, and inpatient care were retrieved from national registries. Mean differences in healthcare consumption costs (United States dollars [$], 2024 prices) between groups were analyzed using generalized linear models. The cost analysis took a healthcare payer perspective and oxygen therapy costs are presented separately as out-of-pocket payments. RESULTS: During the 12 months of follow-up, patients prescribed LTOT for 24 hours/day had significantly lower mean costs for respiratory-specific medications (-$175 [95% CI, -$329 to -$29]) but higher oxygen therapy costs ($173 [95% CI, $80 to $268]), compared to patients prescribed LTOT 15 hours/day. There were no significant differences between the groups in mean specialized outpatient and inpatient care costs, total medication costs, or in overall total costs (-$4951 [95% CI, -$10 667 to $443]) but numerically favoring usage of LTOT 24 hours/day. A population-level projection shows substantial potential cumulative cost savings of $7.64 million if LTOT 24 hours/day is adopted. CONCLUSIONS: In addition to previously shown similar treatment efficacy, overall healthcare costs did not significantly differ between LTOT prescribed 15 hours/day and LTOT 24 hours/day. However, there is an observable numerical difference in favor of usage of LTOT 24 hours/day.