Understanding the Insurance Landscape of Dupuytren’s Contracture Management

Abstract

<i>Background</i>: Dupuytren’s contracture is a fibroproliferative disorder that often results in contractions of the fourth and fifth digits of the hand. While there is no definitive cure, symptomatic relief can be achieved via open fasciotomy, percutaneous aponeurotomy, or through collagenase <i>Clostridium Histolyticum</i> injections (CCH). Despite these therapeutic options, the insurance coverage of these modalities is not clearly defined. <i>Methods</i>: The authors evaluated American insurance companies’ coverage for the treatment of Dupuytren’s and compared the coverage of open fasciotomy, percutaneous aponeurotomy, or CCH. A cross-sectional analysis of US insurance policies for coverage of Dupuytren’s treatment was performed. Companies were selected based on those with the largest enrollment and their market share. <i>Results</i>: Of the 100 companies examined, only 5% of companies had an established policy that covered an open fasciotomy treatment, 6% had a policy that covered a percutaneous fasciotomy, whereas 37% had a policy for CCH. There were significantly more policies for CCH compared to open fasciotomy and percutaneous fasciotomy (CCH vs open fasciotomy: <i>p</i><0.001; CCH vs percutaneous fasciotomy: <i>p</i><0.001). The most common criterion for treatment options was the involvement of the MP joint or PIP (Open fasciotomy <i>n</i> = 5 (100%); percutaneous fasciotomy <i>n</i> = 5 (83.3%); CCH <i>n</i> = 30 (81.1%). <i>Conclusion</i>: There are noted coverage discrepancies between companies for the coverage of Dupuytren’s management. This variability is overall lacking in surgical, minimally invasive, and injection options.