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Updated: Aug 6, 2026
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Published on: December 5, 2025
Conservative versus liberal oxygen therapy in hypoxic ischemic encephalopathy following cardiac arrest: a trial-based
Zhomart Orman1, Carol Hodgson1, Michael Bailey1
1Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 509 St Kilda Road, Melbourne, Victoria 3004, Australia.
Background:
The cost-effectiveness of conservative versus liberal oxygen therapy in critically ill adults with post-cardiac arrest hypoxic ischemic encephalopathy is unknown.
Methods:
A cost-effectiveness analysis alongside the LOGICAL trial was conducted from a health system perspective. Conservative oxygen targeted arterial oxygen saturation (SpO2) of 90-95% using the lowest fraction of inspired oxygen (FiO2), while liberal oxygen had no upper SpO2 limit and a minimum FiO2 of 0.3 during invasive ventilation. Patient-level data were analyzed from 53 intensive care units (ICU) in Australia, New Zealand, and Ireland. Costs (2024, US$) included ICU, ward, and inpatient rehabilitation stays. Health outcomes included favorable functional outcome (Glasgow Outcome Scale-Extended score 5-8) and quality-adjusted life years (QALYs) at 180 days derived from EQ-5D-5L. Uncertainty was explored using bootstrapping. Discounting was not applied.
Results:
Among 1821 participants (median age 62 years; 28.6% female), 873 were randomized to conservative and 948 to liberal oxygen. Mean per-patient cost was $33,629 ($33,517) in the conservative group, with an incremental cost of -$1392 (95% CI, -$4696 to $1911). Favorable functional outcome occurred in 38.2% with conservative oxygen (risk difference, -1.5 percentage points; 95% CI, -6.1 to 3.2). Incremental QALYs were -0.002 (95% CI, -0.013 to 0.008). Conservative oxygen was associated with cost-savings of $635,151 per QALY forgone with considerable uncertainty (>55% bootstrapped replications). Incremental net monetary benefit was $1173 (95% CI, -$2096 to $4442) at $100,000 per QALY.
Conclusions:
Conservative oxygen was associated with modest cost savings and small differences in health outcomes, with no clear economic advantage over liberal oxygen. Trial number: ACTRN12621000518864.
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