Decision analysis in aerospace medicine: Costs and benefits of a hyperbaric facility in space

Introduction: Assembly and maintenance of the International Space Station (ISS) requires an unprecedented number of spacewalks, which expose astronauts to the risk of decompression sickness (DCS). We illustrate the use of decision analysis to compare a hyperbaric oxygen (HBO) chamber to currently available therapy for DCS treatment on the ISS. Methods: A decision-analytic model that simulates events over the lifespan of the ISS was constructed. inputs to the model for probabilities, costs, and measures of morbidity and mortality were derived from a variety of sources, including a systematic literature review and an iterative consultation process with personnel at the Canadian Space Agency and the National Aeronautics and Space Administration (NASA). The decision model was analyzed using the methods of Monte-Carlo simulation and expected value calculation. Main outcome measures included the present value of costs and quality adjusted life years (QALYs), and the cumulative probability of mission-related events over the life cycle of the ISS. Sensitivity analysis was performed. Results: The HBO chamber strategy is associated with a mean cost of -$12.5 million (a net cost saving of $12.5 million) with a 95% Cl (-$112.8 million, $51.3 million). An HBO chamber reduces the likelihood of a premature shuttle return and a premature Soyuz return by 8% and 3%, respectively. The result is sensitive to the lifespan of the ISS. Conclusions: At a $50 million cost, an HBO chamber is likely, though not certain, to result in cost savings. Decision analysis is a useful tool for use in priority setting in aerospace medicine.