HOME OXYGEN-THERAPY

Long-term oxygen therapy (LTOT) has been shown to be of substantial be nefit in the management of patients with advanced chronic obstructive pulmonary disease (COPD) and chronic hypoxemia. Two multicenter studie s of home oxygen therapy (HOT) for COPD patients with hypoxemia demons trated increased survival that is greatest when oxygen is provided nea rly continuously, as opposed to nocturnal oxygen or oxygen for shorter periods of time during the day.(33, 41) In addition to increased surv ival, LTOT results in an improved quality of life that includes increa sed exercise tolerance and enhanced neuropsychiatric function.(14, 26, 32, 40, 45) Physiologic improvements may include a reduction in pulmo nary artery pressure, attenuated progression of pulmonary hypertension , and reduced hematocrit when erythrocythemia is present.(1, 30, 33, 4 0, 43) It is also notable that no medication other than oxygen has bee n demonstrated to increase survival in such patients, although other d rugs to help improve quality of life.(3) Estimates of the magnitude of use of home oxygen in the United States, based on Medicare data of 19 93, indicate that 616,000 patients are receiving home oxygen, at an an nual cost of $1.4 billion.(37) The overall incidence of use of HOT in the United States was 241 per 100,000 persons. The cost of HOT in the United States in 1993 exceeded the entire annual budget of the Nationa l Heart, Lung and Blood Institute. It is not surprising, therefore, th at the Health Care Financing Administration (HCFA), which funds Medica re, has attempted to establish very specific indications for reimburse ment and has continuing concerns about the level of payment and possib le abuse of this therapy.