Abstract
Background: Collagenase clostridium histolyticum (CCH) injection is an established alternative to surgical fasciectomy in selected patients with Dupuytren’s contracture. Collagenase is currently not listed on the Pharmaceutical Benefits Scheme creating a barrier to its use in the Australian public health system. This study compares the cost of CCH delivered in an outpatient setting with a comparable surgical fasciectomy cohort, calculated retrospectively.
 Methods: A retrospective audit of hospital data was conducted to determine the cost of single-digit surgical fasciectomy compared to CCH treatment delivered in an outpatient setting. Medicare Benefits Schedule coding was used to identify surgical fasciectomy patients between March 2014 and April 2015. The CCH group was prospectively followed from June 2014 to March 2016.
 Results: Thirty-seven patients were successfully treated with CCH, with one patient requiring two injections. This group required less follow-up visits (4.0 outpatient clinic and 4.9 allied health) compared to the surgical group (n=38; 4.4 outpatient clinic and 6.1 allied health). The total cost of treatment for the CCH group was AU$2589 compared to a mean total of AU$6155 for the surgical group (AU$3574– AU$14,599)—a potential saving of AU$119,698.
 Conclusion: The overall cost of CCH is substantially lower than surgical fasciectomy despite the cost of the medication (AU$1206). Additionally, CCH patients avoid a visit to the operating room thereby freeing up theatre time that is generally under pressure with long public waiting lists.
Highlights
Dupuytren’s disease is a benign fibroproliferative condition of the palmar fascia characterised by painless, progressive and irreversible contractures of the fingers and subsequent functional limitation
The purpose of this paper is to compare the cost of Collagenase clostridium histolyticum (CCH) treatment in an outpatient setting in the Australian public system with single-digit fasciectomy
Outpatient visits for the fasciectomy group were compared with the CCH group (Table 2)
Summary
Dupuytren’s disease is a benign fibroproliferative condition of the palmar fascia characterised by painless, progressive and irreversible contractures of the fingers and subsequent functional limitation. Fasciectomy for Dupuytren’s disease is a lengthy procedure requiring several weeks to recover motion and strength in the hand. It can vary from excision of segments of the cord through small incisions, or limited fasciectomy of the involved digits, to extensive dermofasciectomy involving skin and fascia. Reported contracture recurrence rates after surgery vary widely from 27 per cent to 80 per cent depending on the definition of recurrence.. Collagenase clostridium histolyticum (CCH) injection is an established alternative to surgical fasciectomy in selected patients with Dupuytren’s contracture. This study compares the cost of CCH delivered in an outpatient setting with a comparable surgical fasciectomy cohort, calculated retrospectively
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