PMS29 Cost-Effectiveness of Collagenase Clostridium Histolyticum, Limited Fasciectomy, and Percutaneous Needle Fasciotomy in the Treatment of Dupuytren's Contracture

Abstract

To determine the cost-effectiveness of treating Dupuytren's contracture with collagenase clostridium histolyticum (CCH), limited fasciectomy (LF), and percutaneous needle fasciotomy (PNF). A Markov decision model was constructed based on published reports of effectiveness, adverse consequences, population-based preferences, and medical costs for the treatment of Dupuytren's contracture – a debilitating condition of the hands. The study perspective was from that of a US payer, such as a commercial insurer. The Markov model classified patients as either experiencing 1) clinical success after treatment; 2) treatment failure –resulting in the need for revision procedures; 3) disease progression; or 4) death. The model used yearly cycles over a 30-year period and took into account recurrence rates and common side effects with each treatment. Clinical trials evaluating the efficacy of the three approaches to treatment defined clinical success inconsistently. As a consequence, the primary analysis assumed equal efficacy across the treatments. Probabilistic sensitivity analysis was conducted using a Monte Carlo simulation with distributions for efficacy, adverse events, and costs. A societal discount rate of 3% was used for both cost and effect. The results are presented in terms of cost per quality-adjusted life years (QALYs). The estimated mean (SD) costs over the 30-year period for CCH, LF, and PNF were $4,489 (418), $18,345 (294), and $14,970 (599), respectively. The number of QALYs for CCH was 14.10, 14.05 for LF, and 14.02 for PNF. Both LF and PNF were dominated by CCH. Sensitivity analysis confirmed the model was sensitive to changes in clinical efficacy. Cost-effectiveness acceptability curves indicated that CCH was most likely to be cost-effective across a wide range of willingness to pay, including values over $100,000 per QALY gained. CCH was less expensive and was associated with slightly more QALYs than LF and PNF for treatment of Dupuytren's contracture.