Collagenase clostridium histolyticum for treating Dupuytren’s contracture
Dupuytren’s disease is a benign, slowly progressive fibroproliferative condition, which affects the palmar fascia in the hand. The disease is common, costly and associated with considerable functional impairment. As the disease progresses, cords gradually contract, reeling in the metacarpophalangeal joints and the proximal interphalangeal joints leading to progressive digital flexion deformities. Joint contractures and deformities are painless but may significantly interfere with the activities of daily living and impact upon the ability to work and on quality of life. Overall, approximately 2 million people in the UK are believed to have Dupuytren’s disease. There is no cure for Dupuytren’s disease and the goal of treatment is to restore hand function. Surgery remains the treatment of choice for severe contracture and some cases of moderate symptoms. Collagenase procedure is a novel, non-surgical treatment which has a UK marketing authorisation for the treatment of Dupuytren’s. This project constructed an economic model to estimate the costs and consequences of collagenase histolyticum injections versus alternative surgical strategies. We found that collagenase was more costly and generated fewer QALYs compared with the most commonly used treatment, limited fasciectomy. The economic model was derived from a naive indirect comparison and was hindered by a lack of suitable data. In addition, there was considerable uncertainty about the appropriateness of many assumptions and parameters used in the model.
Outcome and translation
This study brought together all the available evidence on collagenase clostridium histolyticum as an alternative to surgery in adults with Dupuytren’s contracture with a palpable cord, and modelled the relative costs and benefits of different treatment strategies. We recommended that a randomised controlled trial is required to confirm or refute our findings. Such a trial has subsequently been commissioned by the NIHR HTA programme: http://www.nets.nihr.ac.uk/projects/hta/1510204.
Prospero record for this study. (Prospero is an international prospective register of systematic reviews in health and social care).
External collaborators: M Brazzelli, M Cruickshank, A Elders, C Fraser, C Ramsay, C Robertson (HSRU, University of Aberdeen) and D Lawrie (Woodend Hospital, Aberdeen) (Aberdeen Assessment of Technologies Group).
Brazzelli, M., Cruickshank, M., Tassie, E., McNamee, P., Robertson, C., Elders, A., Fraser, C., Hernández, R., Lawrie, D., Ramsay, C. (2015) 'Collagenase clostridium histolyticum for the treatment of Dupuytren's contracture: systematic review and economic evaluation', Health Technology Assessment, 19(90).