OHP-017 Effect of introducing Clostridium hystoliticum collagenase for treating Dupuytren disease in a hospital

Abstract

Background Dupuytren’s disease leads to progressive finger contractures, limiting hand function. Traditional treatment consists of open partial fasciectomy, which requires hospitalisation, anaesthesia and physiotherapy. Recent introduction of Clostridium hystoliticum collagenase into treatment has minimised the economic impact. Purpose To evaluate the efficacy, safety and financial impact of collagenase versus fasciectomy after its introduction in the hospital. Materials and methods A retrospective observational study was performed in a 400-bed university hospital. All patients treated with collagenase since May 2012 were enrolled in the study. Data were collected from medical histories to study efficacy and safety: sex, age, concomitant disease, pharmacotherapeutic history, previous operations and adverse events. We considered treatment was effective when residual contracture was <5º after 4 weeks of collagenase injection. Costs of surgery and consultation were obtained from the GECLIF (Financial Clinical Management) application. The cost of collagenase was calculated based on the average price of its acquisition by the pharmacy. The average cost of fasciectomy includes costs of surgery, hospital stay and associated consultations. Average cost of treatment with collagenase includes the cost of the drug and associated consultations. We compared average costs between the two treatments using the T-Student-Fisher Test. Confidence intervals were calculated for a confidence level of 95% (CI95%) and p values ≤0.05 were considered statistically significant. Results Nine subjects (7 men and 2 women) with an average age of 68 years (range 62–76), diagnosed with Dupuytren’s contracture with palpable cord were enrolled in the study. 55.6% had relapsed after previous surgery. Injectable collagenase was administrated according to Product Information sheet into the metacarpophalangeal joints (66.7% of patients) or interphalangeal joints (33.3% of patients). Residual contracture <5º was achieved in 88.9% (n = 8) of patients. None experienced relapse. One was recently treated, so we have no efficacy results. Mild to moderate adverse events were reported in 88.9% of patients that resolved with appropriate treatment. These included peripheral oedema and hematoma (77.8%), skin lacerations at injection site (44.4%), paresthesia and pain (11.1%), scab, erythema or pruritus (33.3%). Average cost per patient for fasciectomy was 1,503 € and for treatment with collagenase was 923 €. Collagenase treatment cost an average 580 € (509.51–651.06 €, CI95%; p < 0.001) less per patient than fasciectomy. Conclusions Treatment for Dupuytren’s contracture with collagenase is effective and well tolerated in most of patients. It represents a decrease of 38.6% in costs to hospital versus the average cost of fasciectomy per patient. No conflict of interest.