Initial Treatment Choice Affects Cost-Effectiveness and Reintervention Rates for Dupuytren Contracture: A National Census Among Veterans Affairs Patients

Abstract

Background: A multitude of treatments for Dupuytren contracture are available, including both invasive and minimally invasive options. This study compares the reintervention rates and costs associated with various treatment options for Dupuytren disease (DD) within the Veterans Affairs (VA) Health Administration. Methods: Using the Corporate Data Warehouse, a national census was performed including all patients treated for DD in years 2014 to 2020 within the VA health care system. Patients treated with collagenase clostridium histolyticum (CCH), percutaneous needle aponeurotomy (PNA), open fasciotomy, palmar fasciectomy, single finger fasciectomy, and multifinger fasciectomy were compared. The total cost of initial treatment was compared between modalities. The 5-year reintervention rates were compared using a Kaplan-Meier analysis. Results: During the study period, 8530 patients were treated for DD (3501 fasciectomy, 3351 CCH, 880 PNA, 798 fasciotomy). The overall median treatment cost was found to be the least for PNA ( P < .0001). The 5-year reintervention rates were significantly lower for single finger fasciectomy (6.5%), operative fasciotomy (8.2%), and palmar fasciectomy (9%) when compared with PNA (12.3%), multifinger fasciectomy (13.1%), and CCH (14.4%) ( P < .001). However, reintervention rates were comparable between patients treated with PNA, multifinger fasciectomy, and CCH ( P > .05). Conclusions: Within the VA population, PNA is the most affordable procedure per treatment episode and is associated with reintervention rates that are comparable to those of CCH. Multifinger fasciectomy, CCH, and PNA had comparable reintervention rates. The differences in reintervention rates may partially be explained by patients’ willingness to consider additional treatment to correct any remaining or recurrent deformity.

A 10-Year Review of Collagenase Versus Fasciectomy in the Treatment of Dupuytren Contracture

“…treatment choice for DD between 2014 and 2020, narrowly behind fasciectomy with 3501 and 3351 performed, respectively. 5 Both treatment methods are performed substantially more often than percutaneous needle aponeurotomies and fasciotomies at VA hospitals. 5 Discrepancy in the quality of long-term efficacy between collagenase and open fasciectomy was observed anecdotally by providers at our center and was the impetus behind this study.…”

“…Dupuytren disease (DD) is one of the most common disorders of the hand, affecting 5.7% to 11.7% of the global population 1–4 . Between 2014 and 2020, 8530 veterans were treated for DD at Veterans Administration (VA) hospitals 5 . Two of the most prominent treatment methods for persistent contracture at VA hospitals are open surgical fasciectomy and collagenase injections 5 …”

What’s New in Hand and Wrist Surgery

“…Both treatments have similar 5-year recurrence rates of around 50%; in comparison, the rate after surgical fasciectomy is much lower 23,25 . There are some circumstances in which percutaneous treatment is not deemed appropriate and open fasciectomy is recommended.…”

“…The consensus is that CCH provides little to no benefit over percutaneous needle fasciotomy in terms of recurrence or reintervention but is much more expensive 22-24 . Both treatments have similar 5-year recurrence rates of around 50%; in comparison, the rate after surgical fasciectomy is much lower 23,25 . There are some circumstances in which percutaneous treatment is not deemed appropriate and open fasciectomy is recommended.…”

“…There are now quite a few studies that show 5-year results of a collagenase Clostridium histolyticum (CCH) injection for Dupuytren disease compared with other treatment methods, including a randomized controlled trial of 156 patients with 92% follow-up 22 . The consensus is that CCH provides little to no benefit over percutaneous needle fasciotomy in terms of recurrence or reintervention but is much more expensive 22-24 . Both treatments have similar 5-year recurrence rates of around 50%; in comparison, the rate after surgical fasciectomy is much lower 23,25 .…”