Liquid oxygen therapy at home

Institut national d'excellence en santé et en services sociaux (INESSS)

ABSTRACT

INTRODUCTION:

The benefits of long term oxygen therapy (LTOT) for chronic obstructive pulmonary disease (COPD) are well established. Portable oxygen systems have been assessed in an AETMIS report published in 2004. These systems, developed to provide patients who are active outside the home with an oxygen supply include compressed gas systems, liquid oxygen systems, and oxygen concentrators. This report presents the results of a compre-hensive literature review, prepared in response to a request from the Québec Ministry of Health and Social Services to examine the available evidence about the indications, clinical efficiency, and cost-effectiveness of liquid oxygen therapy as well as the implica-tions on the organization of and access to the home oxygen program in Québec.

METHODOLOGY:

A search and review of the scientific literature was undertaken in a number of databases including those of Health Assessment Agen-cies and of the International Network of Agencies for Health Technology Assessment (INAHTA). Other documents and government reports have also been reviewed.

RESULTS:

Although there are no published clinical indi-cations for the use of liquid oxygen systems at home, the prescription criteria of the available guidelines are based on patient's mobility and usage. The lighter liquid oxygen systems are recommended for LTOT-dependent patients who need to go outside their home on a regu-lar basis. There are no existing data which would indi-cate that liquid oxygen systems allow for ex-tended daily duration of therapy or for im-proved quality of life in comparison to other oxygen supply systems (portable or station-ary) . Furthermore, there is limited evidence that this technology is more user-friendly and advantageous than the compressed gas sys-tems. Comparative costs were reported in one study conducted in Sweden which reveals that liquid oxygen is four times as expensive as the standard therapy (concentrator plus portable cylinder). Utilization of liquid oxygen systems and access to this treatment vary within and across jurisdictions, and depend on the pa-tients insurance coverage. In Canada, the use of liquid oxygen systems is higher in Ontario where it is covered by the provincial Home Oxygen Program. In Québec, given the rela-tively higher cost and clinical concerns about added benefit, liquid oxygen systems are of-fered in the public system only as a 'traite-ment d'exception' to patients who spend lengthy periods of time out of their home ei-ther for work or for leisure or need high flow rates. Nevertheless, patients who wish to use these systems can buy one directly from a supplier. New systems of portable oxygen supply, such as a portable concentrator that has been devel-oped in Montreal and is being tested for clini-cal use, may in the future compete as alterna-tives to liquid oxygen therapy.

CONCLUSION:

There is very limited information about the effectiveness of liquid oxygen therapy in comparison to compressed gas delivery sys-tems in terms of enhanced patient compliance, mobility, or quality of life. A small minority of patients with COPD on LTOT who have active lifestyles would likely benefit from the enhanced portability of liquid oxygen therapy. The identification of clinical and social indi-cations or assessment criteria for the use of liquid oxygen therapy should be determined through a process of consensus amongst respi-rologists and decision-makers in Québec, within the context of developing overall guidelines for home oxygen programs.

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