title: Costs for collagenase injections compared with fasciectomy in the treatment of Dupuytren's contracture: a retrospective cohort study.
abstract: OBJECTIVE
  To compare collagenase injections and surgery (fasciectomy) for Dupuytren's contracture (DC) regarding actual total direct treatment costs and short-term outcomes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Orthopaedic department of a regional hospital in Sweden.
  
  
  METHODS
  Patients 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.
  
  
  METHODS
  Treatment 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.
  
  
  METHODS
  Actual 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.
  
  
  RESULTS
  Collagenase 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.
  
  
  CONCLUSIONS
  Treatment of DC with one collagenase injection costs 33% less than fasciectomy with equivalent efficacy at 6 weeks regarding reduction in contracture.
authors.affiliation: Department of Orthopedics Hässleholm-Kristianstad-Ystad, Hässleholm Hospital, Hässleholm, Sweden.
authors.forename: Isam
authors.initials: I
authors.lastname: Atroshi
authors.forename: Emelie
authors.initials: E
authors.lastname: Strandberg
authors.forename: Anna
authors.initials: A
authors.lastname: Lauritzson
authors.forename: Eva
authors.initials: E
authors.lastname: Ahlgren
authors.forename: Markus
authors.initials: M
authors.lastname: Waldén
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017364:Collagenases / Q000008:administration & dosage* / Q000191:economics*; D003365:Costs and Cost Analysis; D004387:Dupuytren Contracture / Q000191:economics* / Q000628:therapy*; D005260:Female; D006801:Humans; D007267:Injections / Q000191:economics; D008297:Male; D019637:Orthopedic Procedures / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D017364:Collagenases