In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren’s contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren’s contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren’s contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively.
In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren’s contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.
Cite this article: Bone Joint J 2013;95-B:1094–1100.
- Dupuytren’s Contracture
- Cost-utility analysis
- Health ecomonics
- Injectable collagenase
- Partial fasciectomy
- Percutaneous needle aponeurotomy
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by P. Baird and first-proof edited by J. Scott.
Supplementary material. Three tables, detailing i) the studies concerning treatment of single-digit Dupuytren’s contracture from which baseline data for reference were identified, ii) the cost analysis for primary procedure for Dupuytren’s treatment and treatment-related nerve injury, and iii) the results from the univariate sensitivity analysis, are available with the electronic version of this article on our website www.bjj.boneandjoint.org.uk
- Received February 12, 2013.
- Accepted April 24, 2013.
- ©2013 The British Editorial Society of Bone & Joint Surgery