Costs for collagenase injections compared with fasciectomy in the treatment of Dupuytren's contracture: a retrospective cohort study

Abstract

ObjectivesTo compare collagenase injections and surgery (fasciectomy) for Dupuytren's contracture (DC) regarding actual total direct treatment costs and short-term outcomes.DesignRetrospective cohort study.SettingOrthopaedic department of a regional hospital in Sweden.ParticipantsPatients aged 65 years or older with previously untreated DC of 30° or greater in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints of the small, ring or middle finger. The collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre. The controls were 16 patients randomly selected among those operated on with fasciectomy at the same centre during the preceding 3 years.InterventionsTreatment with collagenase was given during two standard outpatient clinic visits (injection of 0.9 mg, distributed at multiple sites in a palpable cord, and next-day finger extension under local anaesthesia) followed by night-time splinting. Fasciectomy was carried out in the operating room (day surgery) under general or regional anaesthesia using standard technique, followed by therapy and splinting.Primary and secondary outcome measuresActual total direct costs (salaries of all medical personnel involved in care, medications, materials and other relevant costs), and total MCP and PIP extension deficit (degrees) measured by hand therapists at 6–12 weeks after the treatment.ResultsCollagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy. Total treatment cost for collagenase injection was US$1418.04 and for fasciectomy US$2102.56. The post-treatment median (IQR) total extension deficit was 10 (0–30) for the collagenase group and 10 (0–34) for the fasciectomy group.ConclusionsTreatment of DC with one collagenase injection costs 33% less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture.

Trends in the Treatment of Dupuytren Disease in the United States Between 2007 and 2014

“…19 In terms of overall cost, CCH injections were found to be just below $700 less expensive than fasciectomy. 2 This study had several limitations. The ability to query for procedures in the PearlDiver database is dependent on the availability of specific CPT codes.…”

“…Although CCH costs greater than $3000 per injection, studies have demonstrated fewer follow-up and therapy visits required postprocedure and significantly less overall costs for patients receiving CCH injection as compared to fasciectomy. 2,6,15 Given the disparity in price between the 2 procedures, financial feasibility cannot be discounted as a possible factor involved in the decreasing percentage of patients receiving fasciectomy and the increasing rates of CCH injection. As CCH injections are more commercialized and marketed by the parent company toward individuals through various medias, the use can be expected to increase or at least discussed during clinic visits.…”

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

“…A Spanish study 20 including 91 patients found that CCH was associated with cost savings compared with fasciectomy, ranging from 29% to 51%. A Swedish hospital study 21 of 32 patients found that the total treatment cost for fasciectomy was $2,103, higher than the total treatment cost of CCH of $1,418. The drug cost for CCH was $970/ injection (in 2011e2012).…”

Kosteneffektivität der Behandlung von Patienten mit Dupuytren-Kontraktur mit mikrobieller Collagenase Clostridium histolyticum (Xiapex®) im Vergleich zur partiellen Fasziektomie in Österreich

“…Bei einer Prävalenz von 0,6 bis 31,6 % in den westlichen Industrieländern [6], der sich daraus ableitenden sozioökonomischen Bedeutung der Dupuytren-Kontraktur sowie des Kostendrucks im Gesundheitswesen sind außer der medizinischen Bewertung neuer Behandlungsmethoden im Vergleich zum Goldstandard auch ökonomische Betrachtungen sinnvoll und notwendig. In den vergangenen 2 Jahren sind Kosteneffektivitätsanalysen aus verschiedenen westlichen Industrieländern publiziert worden [7][8][9][10][11] In der statistischen Analyse der Datensätze zeigten sich bei beiden Gruppen hinsichtlich der Altersverteilung (p = 0,097) sowie den präoperativen …”