Cost Comparative Analysis of Dupuytren’s Contracture Treatments

Abstract

Purpose: Currently there is limited literature comparing the cost of Collagenase Clostridium Histolyticum (CCH) injections to surgical fasciectomy to treat Dupuytren’s Contracture (DC). The purpose of this study was to model and compare the cost of these two procedures. Methods: The billing records of four orthopedic surgeons at a tertiary academic center were queried for current procedural terminology (CPT) codes for operative and non-operative treatment of DC. “Cost” was modeled using the reimbursement Medicare would have paid based on the 2017 fee schedule. The modeled cost of each CCH treatment was comprised of materials, surgeon reimbursement for the injection and the manipulation, and hand therapy. The modeled cost of surgery was comprised of anesthesia reimbursement, operating room costs, pathology fee, surgeon reimbursement and hand therapy. Results: This study evaluated a total of 245 patients. There were 178 patients in the CCH injection group and 67 patients in the surgical fasciectomy group. The total modeled cost of treatment with CCH was 5,153.23 USD and the total cost of surgery was 6,137.41 USD (p=.001). CCH injection was less expensive than surgery regardless of whether one digit was treated, or multiple digits were treated (p=0.005). Conclusion: In this cost model, CCH injection is a less expensive option to treat DC compared to fasciectomy. Level of Evidence: II, Economic and Decision Analyses