title: Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.
abstract: In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. heather.baltzer@utoronto.ca
authors.forename: H
authors.initials: H
authors.lastname: Baltzer
authors.forename: P A
authors.initials: PA
authors.lastname: Binhammer
mesh_terms: D000465:Algorithms; D002170:Canada; D017364:Collagenases / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016527:Drug Costs / Q000706:statistics & numerical data; D004387:Dupuytren Contracture / Q000191:economics* / Q000628:therapy*; D000071938:Fasciotomy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015552:Injections, Intralesional; D017059:Models, Econometric; D011183:Postoperative Complications / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: D017364:Collagenases
keywords: Cost-utility analysis; Dupuytren’s Contracture; Health ecomonics; Injectable collagenase; Partial fasciectomy; Percutaneous needle aponeurotomy