A National Mandate for Thermal Fuses for Home Oxygen Users is Cost-Effective in the Prevention of Burn Morbidity, Mortality, and Property Loss

Abstract

Smoking while using home oxygen leads to explosions, which cause cutaneous burns, death, and loss of property. Thermal fuses interrupt the propagation of ignited oxygen lines and reduce the risk of injury. Prior to mandating thermal fuses for all home oxygen users in the United States, cost-effectiveness analysis should be performed. A Markov model was constructed for suffering a thermal injury while smoking on home oxygen. Societal and Medicare perspectives were adopted, evaluating the costs of a federal policy, including purchasing/shipping thermal fuses to all home oxygen users. Costs included the healthcare required to treat burn patients and extend lives in advanced chronic obstructive pulmonary disease. Cost savings included the avoided property loss. Effectiveness was measured in gains in quality adjusted life years (QALYs). In the status quo, the 10-year societal cost was $28.67 billion compared to $28.36 billion in the policy mandate (saving $305.40 million at 10 years). 1812 QALYs were gained with the policy mandate, yielding, and incremental cost-effectiveness ratio (ICER) of -$160 317. From the Medicare payor perspective, the ICER was $64 981. Deterministic and probabilistic sensitivity analyses showed little variation in the ICER under multiple scenarios. The discrepancy between the dominant ICER for a societal perspective and the cost-effective ICER for a Medicare perspective reflected savings from averted property loss not realized by Medicare. A national policy mandating and paying for thermal fuses for all home oxygen users is dominant from a societal perspective and cost-effective from a Medicare perspective. The US government should adopt such a policy.

Keywords: burn; chronic obstructive pulmonary disease; cost-effectiveness; fire; home oxygen; inhalation injury; prevention.