Cost-effectiveness of Recurrent Dupuytren Contracture Treatment

Abstract

IMPORTANCE Owing to its tendency to recur, Dupuytren contracture often requires multiple treatments, which places additional economic burden on health care. The likelihood of contracture recurrence varies not only with treatment but also with disease characteristics, such as contracture severity and location, but prior cost-effectiveness analyses of Dupuytren contracture treatments have not considered these patient-specific disease characteristics. OBJECTIVE To identify the most cost-effective treatment regimen for patients with recurrent Dupuytren contracture. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted with statetransition microsimulation modeling using data from published studies and Medicare. A simulated cohort of 10 000 individuals with Dupuytren contracture was created. Patients could transition yearly between the following health states: symptom-free, symptomatic, and death. Available treatments were collagenase clostridium histolyticum injection, percutaneous needle aponeurotomy (PNA), and limited fasciectomy (LF); individuals randomly chose any treatment when symptomatic. Patients were limited to 3 rounds of treatment for a contracture affecting 1 joint, totaling 27 unique combinations. If the contracture recurred after 3 treatments, patients lived with the disease for the remainder of life.

The CeCORD-J study on collagenase injection versus aponeurectomy for Dupuytren's contracture compared by hand function and cost effectiveness

“…Recurrences were reported in 160 of 199 digits (80%) at an average of 7.2 years after collagenase injection despite a heterogeneous patient population 17 . Furthermore, Yoon et al simulated recurrent DC in a 60-year-old patient and concluded that collagenase injections are not a cost-effective intervention and should not be preferred over percutaneous needle aponeurotomy or limited fasciectomy 18 . Leafblad et al retrospectively reviewed 848 interventions for DC, and reported 2-year reintervention rates following needle aponeurotomy, collagenase, and fasciectomy of 24%, 41%, and 4%, respectively, and 5-year rates of 61%, 55%, and 4%, respectively 19 .…”

Dupuytren's Disease: An Outcomes-Focused Update

“…Recent level II evidence for 5-year recurrence (defined as a 30degree increase in passive extension deficit) indicates that the combined recurrence of PIP and MCP joint contracture is 84.9, 32, and 21% for needle aponeurotomy, collagenase injection, and open fasciectomy, respectively. 69…”

Associations among quality of life, activities, and participation in elderly residents with joint contractures in long-term care facilities: a cross-sectional study

“…The rapid increase in global life expectancy indicates that joint contractures and osteoarthritis (OA), the most common joint diseases in the elderly population [ 1 , 2 ], are becoming major global public health issues [ 3 ]. Joint contractures are present in more than 20% of elderly residents in long-term care facilities (LTCFs), and more than 10% develop symptoms of OA [ 1 ].…”