Cost per Episode of Care With Collagenase Clostridium histolyticum Versus Fasciectomy for Dupuytren Contracture: A Real-World Claims Database Analysis

Abstract

Purpose: To quantify the total cost for a 3-month episode of care after treatment with collagenase Clostridium histolyticum (CCH) (Xiaflex) versus fasciectomy for Dupuytren contracture (DC) in the United States. Methods: Adult patients treated for DC (single finger only) with either CCH or fasciectomy from January, 2012 to June, 2016 were identified (the first treatment was the index date) from the IQVIA Real-World Data Adjudicated Claims-US Database. Patients had continuous health plan enrollment 360 days or more pre-index (pre-index) and 90 days or more post-index (follow-up), and one or more pre-index medical claims with a DC diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification 728.6; International Classification of Diseases, 10th Revision, Clinical Modification M72.0). Patients with pre-index treatment for DC were excluded. The primary outcome was the comparison of all-cause and DC-specific health care costs paid by the health plan over the 3-month follow-up. We defined DC-specific as claims with a DC diagnosis, DC-related therapies, and all claims associated with the index date and day after. Generalized linear models compared adjusted all-cause and disease-specific total costs. Results: A total of 1,654 CCH and 2,745 fasciectomy patients were identified (mean age, 59.7 and 58.0 years; 81.8% and 74.4% male; respectively). Fasciectomy patients had higher mean total all-cause costs compared with CCH patients in the follow-up ($8,519 vs $7,657). Fasciectomy patients had higher mean costs related to outpatient surgical visits ($3,592 vs $826), physician office visits, and laboratory and pathology tests, but lower mean costs for all other services (outpatient ancillary and Healthcare Common Procedure Coding System drugs) ($2,901 vs $4,748) and inpatient care. Similarly, fasciectomy patients had higher mean total DC-specific costs ($6,204 vs $5,038). In adjusted analyses, CCH patients were associated with reductions in total all-cause (11.5%) and DC-specific (20.0%) health care costs. Conclusions: Collagenase C histolyticum for the treatment of DC was associated with a 12% reduction in the total cost of care compared with that for fasciectomy. The higher costs associated with fasciectomy were primarily driven by outpatient surgery costs. Type of study/level of evidence: Economic/Decision Analysis II. Key words: Collagenase Clostridium histolyticum, Dupuytren contracture, fasciectomy, health care costs, retrospective study