Main Article Content
Dupuytren contracture, collagenases, clostridium histolyticum, fasciotomy, injections
Background: Collagenase, an enzyme produced by clostridium histolyticum (CCH), is a relatively new injection able to cleave collagen strands in vitro. While not yet available on the PBS, the side effect profile and risk of recurrence of collegenase injections are comparable to fasciectomy in appropriately selected patients. In this study, we aimed to demonstrate the safety and cost-effectiveness of collagenase for the treatment of Dupuytren’s disease.
Method: Twenty-five patients at our hospital received collagenase injections for treatment of their Dupuytren’s disease. Data from this cohort was compared to a hypothetical group extrapolated from the literature.
Results: Surgical treatment, excluding outpatient visits, costs on average AU$5852 per patient and collagenase costs AU$1176 per patient (gross cost difference AU$4676). Moderating this cost difference by the effect of complications using the incremental cost effectiveness ratio, the cost saving is AU$1137.71 per unit decrease in complications with collagenase treatment. Surgical fasciectomy has a lower risk of recurrence than collagenase but costs up to AU$543 more for patients for whom the condition does not recur within five years of treatment. In our cohort, 25 patients had 31 cords injected with collagenase. All but two patients achieved full range of motion of their affected joint and 20 per cent sustained minor skin tears requiring dressings.
Conclusion: This analysis suggests that the investment of public health funds in the treatment of suitable patients with collagenase should produce a substantial cost saving without increasing the risk of complications.
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