Cost per Episode of Care With Collagenase Clostridium histolyticum Versus Fasciectomy for Dupuytren Contracture: A Real-World Claims Database Analysis

Abstract

Purpose: To quantify the total cost for a 3-month episode of care after treatment with collagenase Clostridium histolyticum (CCH) (Xiaflex) versus fasciectomy for Dupuytren contracture (DC) in the United States. Methods: Adult patients treated for DC (single finger only) with either CCH or fasciectomy from January, 2012 to June, 2016 were identified (the first treatment was the index date) from the IQVIA Real-World Data Adjudicated Claims-US Database. Patients had continuous health plan enrollment 360 days or more pre-index (pre-index) and 90 days or more post-index (follow-up), and one or more pre-index medical claims with a DC diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification 728.6; International Classification of Diseases, 10th Revision, Clinical Modification M72.0). Patients with pre-index treatment for DC were excluded. The primary outcome was the comparison of allcause and DC-specific health care costs paid by the health plan over the 3-month follow-up. We defined DC-specific as claims with a DC diagnosis, DC-related therapies, and all claims associated with the index date and day after. Generalized linear models compared adjusted all-cause and disease-specific total costs. Results: A total of 1,654 CCH and 2,745 fasciectomy patients were identified (mean age, 59.7 and 58.0 years; 81.8% and 74.4% male; respectively). Fasciectomy patients had higher mean total all-cause costs compared with CCH patients in the follow-up

Return-to-Function Following Treatment of Dupuytren Contracture With Collagenase Clostridium Histolyticum Versus Fasciectomy

“…In addition, the percentage of patients receiving opioid analgesics during the 12 months prior to the index date was significantly lower in the CCH cohort compared with the fasciectomy cohort (28.9% vs 38.5%; P < .001), but there was no significant difference between the 2 groups in the percentage of patients using NSAIDs. 13 Fewer patients in the CCH cohort used opioid analgesics or NSAIDs during follow-up (P < .0001 for both), and patients in the CCH cohort were significantly less likely to be new users of these medications (P < .0001 for both; Figure 1). In addition, during follow-up, 806 (48.7%) of the 1654 patients in the CCH cohort had ≥1 all-cause PT visit compared with 1717 (62.6%) of the 2745 patients in the fasciectomy cohort (P < .0001).…”

“…These studies are supported by a 2019 retrospective analysis of a US adjudicated claims database, using data from 2011 to 2016, which demonstrated that CCH treatment of DC was associated with an 11.5% reduction in total all-cause episode-of-care costs compared with fasciectomy ( P < .001). 13 The higher costs associated with fasciectomy were primarily driven by outpatient surgery costs and higher costs for physician office visits and laboratory/pathology tests.…”

Treatment Patterns and Healthcare Outcomes with Collagenase Clostridium Histolyticum vs Surgery in Peyronie's Disease: A Retrospective Claims Database Analysis

“…However, despite the small absolute numbers, the relative findings can be generalized to other U.S. commercially insured patients, given the broad sampling across the country. 16 Inclusion of patients receiving penile prostheses in the surgery cohort is a limitation, given that this subgroup of patients likely represents a distinct population that may experience greater rates of postoperative pain and hospitalizations compared with groups of patients receiving other interventions. The frequencies of treatments reported during the study period likely underestimates the total number of surgical procedures and CCH injections performed annually.…”

“…The database is considered to be representative of the U.S. insured population with regard to age and sex. 16 This database is further described by Camper et al (2019). 16 …”

Dupuytren’s disease

“…In the US, the use of CCH has been increasing over the past decade, leading to an associated decrease in percutaneous needle fasciotomy and fasciectomy 37. The cost effectiveness of this approach is under discussion—one study found that CCH injection can reduce the total cost of care by 12% compared with fasciectomy 38. The main body of evidence for CCH comes from two recent randomised controlled trials3334 designed to compare the effectiveness of the enzyme with a placebo injection.…”