Abstract
BackgroundDupuytren’s disease (DD) is a common and progressive, fibroproliferative disorder of the palmar and digital fascia of the hand. Various treatments have been recommended for advanced disease or to retard progression of early disease and to prevent deterioration of the finger contracture and quality of life. Recent studies have tried to evaluate the clinical and cost-effectiveness of therapies for DD, but there is currently no systematic assessment and appraisal of the economic evaluations.MethodsA systematic literature review was conducted, following PRISMA guidelines, to identify studies reporting economic evaluations of interventions for managing DD. Databases searched included the Ovid MEDLINE/Embase (without time restriction), National Health Service (NHS) Economic Evaluation Database (all years) and the National Institute for Health Research (NIHR) Journals Library) Health Technology Assessment (HTA). Cost-effectiveness analyses of treating DD were identified and their quality was assessed using the CHEERS assessment tool for quality of reporting and Phillips checklist for model evaluation.ResultsA total of 103 studies were screened, of which 4 met the study inclusion criteria. Two studies were from the US, one from the UK and one from Canada. They all assessed the same interventions for advanced DD, namely collagenase Clostridium histolyticum injection, percutaneous needle fasciotomy and partial fasciectomy. All studies conducting a cost-utility analysis, two implemented a decision analytic model and two a Markov model approach. None of them were based on a single randomised controlled trial, but rather synthesised evidence from various sources. Studies varied in their time horizon, sources of utility estimates and perspective of analysis. The overall quality of study reporting was good based on the CHEERS checklist. The quality of the model reporting in terms of model structure, data synthesis and model consistency varied across the included studies.ConclusionCost-effectiveness analyses for patients with advanced DD are limited and have applied different approaches with respect to modelling. Future studies should improve the way they are conducted and report their findings according to established guidance for conducting economic modelling of health care technologies.Trial registrationThe protocol was registered (CRD42016032989; date 08/01/2016) with the PROSPERO international prospective register of systematic reviews.
Highlights
Dupuytren’s disease (DD) is a common and progressive, fibroproliferative disorder of the palmar and digital fascia of the hand
Summary of studies included in the review The searches of Ovid Medline, Embase and NHS EED identified 102 studies, and one additional publication was included from cross-references
Fifty-one of these publications were not eligible for inclusion in the review: 32 did not include an economic evaluation, 14 reported a cost-analysis only, 3 conducted a quality of life analysis only, and 2 manuscripts were a letter to the editor and an erratum
Summary
Dupuytren’s disease (DD) is a common and progressive, fibroproliferative disorder of the palmar and digital fascia of the hand. Dupuytren’s disease (DD) affects 4% of the general UK population and is a progressive, fibro-proliferative condition affecting the palmar and digital fascia of the hand, the ‘bands’ that anchor the skin of the palm [1,2,3]. Manifestation of the disease is as a firm nodule These nodules are the precursors to the development of fibrous collagenous cords which extend into the fingers. 40% of patients with early disease might eventually be expected to progress to develop cords [4, 5] and the flexion deformities that impair hand function, thereby greatly limiting activities of daily life, including self-care, usual activities and employment, and reducing health-related quality of life (HRQoL) [6]. 11a Measurement of effectiveness (single study-based estimates). 13a Estimating resources and costs (single study-based economic evaluation)
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