title: The Impact of Collagenase Clostridium histolyticum Introduction on Dupuytren Treatment Patterns in the United States.
abstract: OBJECTIVE
  The U.S. Food and Drug Administration approved the use of collagenase Clostridium histolyticum (CCH) in the United States in February 2010. This study addresses the impact of that approval on the number of Dupuytren contracture (DC) encounters and treatment patterns in the United States.
  
  
  METHODS
  Using the Intercontinental Marketing Services Health Office-Based Medical Claims database, we identified the monthly number of DC encounters and DC procedures between January 2007 and December 2013. Collagenase Clostridium histolyticum usage data from March 2010 to December 2013 was derived from the U.S. CCH manufacturer's data warehouse. Using the combined data, the yearly increasing trends in DC encounters and treatment volume were compared before and after the introduction of CCH. Time trends in the relative procedure frequencies were then examined. Finally, the presence of seasonal variation was tested for in each treatment type.
  
  
  RESULTS
  Dupuytren contracture encounters increased on average by 19,015 per year between 2007 and 2009, whereas between 2011 and 2013, DC encounters increased on average by 34,940 per year. In terms of absolute procedure counts, the surgery trend line began decreasing in 2010 with the release of CCH. Meanwhile, CCH continuously increased between 2010 and 2013, and needle aponeurotomy (NA) remained relatively stable. By the year 2013, minimally invasive techniques (NA and CCH) comprised 39% of all treatment, compared with only 14% in 2007. Lastly, there was a statistically significant seasonal increase in the number of surgical procedures during the wintertime but no seasonal variation in NA or CCH.
  
  
  CONCLUSIONS
  After the introduction of CCH, the number of Dupuytren encounters increased at a greater annual rate. The introduction and growth of CCH coincided with a decrease in surgery. The number of NA procedures remained steady throughout the study period. The number of open surgery cases followed a predictable seasonal variation with more procedures during the winter months, but this seasonal variation was not seen with less invasive techniques.
  
  
  METHODS
  Economic/Decision Analysis II.
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: John Z
authors.initials: JZ
authors.lastname: Zhao
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Scott
authors.initials: S
authors.lastname: Hadley
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Emerson
authors.initials: E
authors.lastname: Floyd
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Brandon E
authors.initials: BE
authors.lastname: Earp
authors.affiliation: Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: pblazar@partners.org.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Blazar
mesh_terms: D015331:Cohort Studies; D016208:Databases, Factual; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D015552:Injections, Intralesional; D008297:Male; D003012:Microbial Collagenase / Q000627:therapeutic use*; D010147:Pain Measurement; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration
chemical_list: D003012:Microbial Collagenase
keywords: Collagenase; Dupuytren; treatment patterns