Abstract
Background
Collagenase represents a novel non-surgical treatment for Dupuytrens disease. Xiapex (Injectable collagenase, Pfizer pharmaceuticals) was recently approved by the MHRA for clinical use. The main objective of this study was to assess the proportion of patients with Dupuytrens disease that are suitable for treatment with collagenase and the financial implications of its introduction.
Methods
All new patients diagnosed with Dupuytrens disease over a three month period (Sept-Nov) were enrolled into study. Patients were assessed in clinic by a senior surgeon. All patients with a palpable Dupuytrens cord without significant skin tethering were offered collagenase. Comparisons were made with the corresponding quarter in the previous 2 years. Management trends were compared over the three years (2009–11) to identify the impact of collagenase. Cost effectiveness analysis was based on a comparison with costs incurred by a fasiectomy, the most common intervention in the management of Dupuytrens disease.
Results
Total number of patient referrals was relatively static over the three years with a range of 269 to 285. 23 (36.9%) of 58 patients received collagenase in the time period it was available. Needle fasiotomies which accounted for 11/76 (14%) procedures in 2009 and 5.2% of procedures in 2010 was not performed once collagenase was available. There was a significant reduction in the number of fasiectomies performed over the three year period. 42% (28/58) of procedures performed were fasiectomies in 2010 this had significantly fallen to 32% (21/58) in 2011. Dermofasiectomies were stable over the three year 17% in 2009 to 13% in 2011 with the introduction of collagenase. Cost effectiveness analysis revealed a significant reduction in cost with collagenase.
Conclusions
Upto 40% of patients with established Dupuytrens disease maybe suitable for management with collagenase. This represents a cost-effective, clinically effective non-surgical option in the management of Dupuytrens disease
