Current trends in the surgical management of Dupuytren’s disease in Europe: an analysis of patient charts

Bainbridge, L. C.; Dahlin, Lars B.; Szczypa, Piotr; Cappelleri, Joseph C.; Guérin, Daniel; Gerber, Robert A.

doi:10.1007/s12570-012-0092-z

Cited by 39 publications

(56 citation statements)

References 19 publications

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“…According to Bainbridge et al, the overall complication rate during surgery is at 4% with the most frequent being injury of nerves, arteries or the volar plate [21].…”

Section: Treatment Of Dupuytren's Contracturementioning

confidence: 99%

“…The most frequent postoperative complications are hematoma (8%), wound healing disorder or delay (6%), inflammation and infection (6%) and pain (6%) [21]. These are seen particularly in more invasive surgical techniques.…”

Section: Treatment Of Dupuytren's Contracturementioning

confidence: 99%

“…Because of the interplay of genetic predisposition, environmental factors and its special pathophysiology, a surgical excision can never be curative [1][2][3][21][22][23].…”

Section: Treatment Of Dupuytren's Contracturementioning

confidence: 99%

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Dupuytren’s contracture: the status and impact of collagenase Clostridium histolyticum treatment in Austria

et al. 2017

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Background: Over many decades, the treatment of Dupuytren's disease, a fibroproliferative disease of the hand, is the centre of various studies and publications. Surgical intervention has always been the method of choice, with fasciectomy being today's state of the art. Nevertheless, researchers also focused on conservative non-operative treatment methods of which collagenase Clostridium histolyticum (CCH) turned out to be very promising. With the release of CCH under the name Xiapex in 2010, its use increased steadily. The aim of this work is to survey the current state of the treatment with CCH and the status of Xiapex treatment in Austria. Methods: On behalf of the Division of Plastic, Aesthetic and Reconstructive Surgery at the Medical University of Graz, a questionnaire was sent out to departments and doctors in Austria that are treating Dupuytren's disease. Based on this expert interrogation data concerning treating patterns, complications, outcome, etc. has been collected.

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“…According to Bainbridge et al, the overall complication rate during surgery is at 4% with the most frequent being injury of nerves, arteries or the volar plate [21].…”

Section: Treatment Of Dupuytren's Contracturementioning

confidence: 99%

Section: Treatment Of Dupuytren's Contracturementioning

confidence: 99%

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Dupuytren’s contracture: the status and impact of collagenase Clostridium histolyticum treatment in Austria

et al. 2017

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“…The two non-randomised studies comparing collagenase with surgery 71,72 and the five non-randomised studies comparing various surgical procedures 44,57,[73][74][75][76] were published in full. Three studies collected data prospectively 72,74,75 and three retrospectively.…”

mentioning

confidence: 99%

“…Three studies collected data prospectively 72,74,75 and three retrospectively. 71,73,76 One study did not report this information. …”

mentioning

confidence: 99%

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Brazzelli

Cruickshank

Tassie

et al. 2015

Health Technol Assess

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BackgroundDupuytren’s disease is a slowly progressive condition of the hand, characterised by the formation of nodules in the palm that gradually develop into fibrotic cords. Contracture of the cords produces deformities of the fingers. Surgery is recommended for moderate and severe contractures, but complications and/or recurrences are frequent. Collagenase clostridium histolyticum (CCH) has been developed as a minimally invasive alternative to surgery for some patients.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of collagenase as an alternative to surgery for adults with Dupuytren’s contracture with a palpable cord.Data sourcesWe searched all major electronic databases from 1990 to February 2014.Review methodsRandomised controlled trials (RCTs), non-randomised comparative studies and observational studies involving collagenase and/or surgical interventions were considered. Two reviewers independently extracted data and assessed risk of bias of included studies. A de novo Markov model was developed to assess cost-effectiveness of collagenase, percutaneous needle fasciotomy (PNF) and limited fasciectomy (LF). Results were reported as incremental cost per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were undertaken to investigate model and parameter uncertainty.ResultsFive RCTs comparing collagenase with placebo (493 participants), three RCTs comparing surgical techniques (334 participants), two non-randomised studies comparing collagenase and surgery (105 participants), five non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 collagenase case series (3154 participants) were included. Meta-analyses of RCTs assessing CCH versus placebo were performed. Joints randomised to collagenase were more likely to achieve clinical success. Collagenase-treated participants experienced significant reduction in contracture and an increased range of motion compared with placebo-treated participants. Participants treated with collagenase also experienced significantly more adverse events, most of which were mild or moderate. Four serious adverse events were observed in the collagenase group: two tendon ruptures, one pulley rupture and one complex regional pain syndrome. Two tendon ruptures were also reported in two collagenase case series. Non-randomised studies comparing collagenase with surgery produced variable results and were at high risk of bias. Serious adverse events across surgery studies were low. Recurrence rates ranged from 0% (at 90 days) to 100% (at 8 years) for collagenase and from 0% (at 2.7 years for fasciectomy) to 85% (at 5 years for PNF) for surgery. The results of the de novo economic analysis show that PNF was the cheapest treatment option, whereas LF generated the greatest QALY gains. Collagenase was more costly and generated fewer QALYs compared with LF. LF was £1199 more costly and generated an additional 0.11 QALYs in comparison with PNF. The incremental cost-effectiveness ratio was £10,871 per QALY gained. Two subgroup analyses were conducted for a population of patients with moderate and severe disease and up to two joints affected. In both subgroup analyses, collagenase remained dominated.LimitationsThe main limitation of the review was the lack of head-to-head RCTs comparing collagenase with surgery and the limited evidence base for estimating the effects of specific surgical procedures (fasciectomy and PNF). Substantial differences across studies further limited the comparability of available evidence. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.ConclusionsCollagenase was significantly better than placebo. There was no evidence that collagenase was clinically better or worse than surgical treatments. LF was the most cost-effective choice to treat moderate to severe contractures, whereas collagenase was not. However, the results of the cost–utility analysis are based on a naive indirect comparison of clinical effectiveness, and a RCT is required to confirm or refute these findings.Study registrationThis study is registered as PROSPERO CRD42013006248.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cost-effectiveness of Recurrent Dupuytren Contracture Treatment

et al. 2020

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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.

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Current trends in the surgical management of Dupuytren’s disease in Europe: an analysis of patient charts

Cited by 39 publications

References 19 publications

Dupuytren’s contracture: the status and impact of collagenase Clostridium histolyticum treatment in Austria

Dupuytren’s contracture: the status and impact of collagenase Clostridium histolyticum treatment in Austria

Collagenase clostridium histolyticum for the treatment of Dupuytren’s contracture: systematic review and economic evaluation

Cost-effectiveness of Recurrent Dupuytren Contracture Treatment

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