title: Use of resources and costs associated with the treatment of Dupuytren's contracture at an orthopedics and traumatology surgery department in Denia (Spain): collagenase clostridium hystolyticum versus subtotal fasciectomy.
abstract: BACKGROUND
  Our purpose was to analyze and compare the use of direct health resources and costs generated in the treatment of Dupuytren's contracture using two different techniques: subtotal fasciectomy and infiltration with Collagenase Clostridium Histolyticum (CCH) in regular clinical practice at the Orthopedic and Traumatology Surgery (OTS) Department at the Hospital de Denia (Spain).
  
  
  METHODS
  Observational, retrospective study based on data from the computerized clinical histories of two groups of patients- those treated surgically using a one or two digit subtotal fasciectomy technique (FSC) and those treated with CCH infiltration, monitored in regular clinical practice from February, 2009 to May, 2012. Demographic (age, sex), clinical (number of digits affected and which ones) and use of resources (hospitalizations, medical visits, tests and drugs) data were collected. Resource use and associated costs, according to the hospital's accounting department, were compared based on the type of treatment from Spain's National Health Service.
  
  
  RESULTS
  91 patients (48 (52.8%) in the FSC group) were identified. The average age and number of digits affected was 65.9 (9.2) years and 1.33 (0.48) digits affected in the FSC group, and 65.1 (9.7) years and 1.16 (0.4) digits in the CCH group.Overall, the costs of treating Dupuytren's disease with subtotal FSC amount to €1,814 for major ambulatory surgery and €1,961 with hospital stay including admission, surgical intervention (€904), examinations, dressings and physiotherapy. As to collagenase infiltration, costs amount to €952 (including minor surgery admission, vial with product, office examination and dressings). Finally, comparing total costs for treatments, a savings of €388 is estimated in favor of CCH treatment in the best-case scenario (patient under MAS system with no need for physiotherapy) and €1,008 in the worst-case scenario (patient admitted to hospital needing subsequent physiotherapy), implying a savings of 29% and 51%, respectively.
  
  
  CONCLUSIONS
  This study demonstrates that treating patients with DC by injection with CCH at the OTS department of the Hospital de Denia generates a total savings of 29% and 51% (€388 and €1008) compared with fasciectomy at the time of treatment. Long term evolution of CCH treatment is uncertain and the recurrence rate unknown.
authors.affiliation: Orthopedics and Traumatology Surgery (OTS) Department of the Hospital de Denia, Denia, Alicante, Spain. sanjuan.rafcer@gmail.com.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sanjuan Cerveró
authors.forename: Nuria
authors.initials: N
authors.lastname: Franco Ferrando
authors.forename: Jaime
authors.initials: J
authors.lastname: Poquet Jornet
mesh_terms: D000368:Aged; D047009:Hathewaya histolytica / Q000201:enzymology*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D000071938:Fasciotomy; D005260:Female; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D003012:Microbial Collagenase / Q000191:economics* / Q000302:isolation & purification / Q000627:therapeutic use*; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D009819:Office Visits / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics*; D009985:Orthopedics / Q000191:economics*; D026741:Physical Therapy Modalities / Q000191:economics; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors; D014193:Trauma Centers / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D003012:Microbial Collagenase