Randomised controlled trial (RCT) evidence is generally considered to be the gold standard for assessing the efficacy of healthcare interventions. RCT evidence was not available for a substantial number the HBOT treatment indications. However RCTs may be considered inappropriate for some conditions, such as decompression illness where the theoretical rationale for therapy is accepted. For those conditions where RCTs had been conducted, the quality or reporting of many trials was considered too poor to provide robust
conclusions. As a result, therapeutic efficacy was suggested for a number of HBOT indications but rigorous testing is required to confirm the findings. For the majority of conditions considered within this report it is concluded that there is insufficient evidence to support the routine use of HBOT. For some conditions observational studies have suggested that HBOT may be of some benefit, but conclusive evidence in the form of RCTs is required. A large number of such trials are currently underway and this should provide a better evidence base.
The cost-effectiveness evidence base was limited, with economic evaluations having been carried out for only a few conditions. This review found that most of the cost–effectiveness evidence on HBOT relates to the treatment of diabetic foot ulcers.
