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Systematic Review Comparing Cost Analyses of Fasciectomy, Needle Aponeurotomy and Collagenase Injection for Treatment of Dupuytren's Contracture
Alanna Fitzpatrick, MD; Forough Farrokhyar, PhD; Maleka Ramji, MD; Stuart Martin, MD
McMaster University, Hamilton, ON, Canada

Background: Surgeons now have a variety of treatment options for Dupuytren’s contracture including traditional partial fasciectomy (PF), percutaneous needle aponeurtomy (PNA), and collagenase Clostridium histolyticum (CCH) injection. An important factor in clinical decision making is the cost effectiveness of the various modalities, as will be discussed in this paper.
Methods: A literature search was performed, by two independent reviewers. A total of 8 articles and 3 abstracts met inclusion criteria. Papers were excluded for non-English language, insufficient breakdown of costs by treatment type, promotional materials, or works-in-progress. Cost data was extracted and subsequently converted to U.S. Dollars. A weighted mean was used to objectively pool data that were sufficiently similar in methodology and population.
Results: Four observational cohort studies were pooled and found to have a weighted mean cost in favour of CCH at ,877 per patient (SD .3) compared to PF at ,857 (,348). Two expected-value decision analysis models were in agreement that PF is not cost effective, but they differed on whether PNA or CCH was the most cost effective strategy. Two cost minimization studies agreed that CCH was less costly than PF by . Overall 7 of 11 studies found CCH to be most cost effective. Only one study of eleven found PF to be the most cost effective method. Of the six studies that considered PNA, three found it to be lowest cost.
Conclusion: The vast majority of studies found PF to be the most costly treatment modality, however it is still the treatment of choice in certain clinical scenarios. It is difficult to compare CCH to PNA, as many studies did not consider PNA. More studies, especially considering indirect costs, are required to be able to accurately determine which method is most cost effective.

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