This NIHR HTA-funded evidence synthesis assessed the clinical and cost-effectiveness of collagenase clostridium histolyticum (CCH) injections, within its licensed indication, as an alternative to surgery (including fasciectomy, dermofasciectomy, open fasciotomy and needle fasciotomy) for the treatment of adults presenting with Dupuytren’s disease. Dupuytren’s disease is a slowly progressive condition of the hand, characterised by formation of nodules in the palm which gradually develop into fibrotic cords. Contracture of the cords produces fingers’ deformities. Surgery is recommended for moderate and severe contractures but complications and/or recurrences are frequent. CCH has been developed as a minimally invasive alternative to surgery in some patients. The project considered clinical evidence from five RCTs comparing collagenase with placebo (493 participants), 3 RCTs comparing various surgical procedures (334 participants), 2 non-randomised studies comparing collagenase with surgery (105 participants), 5 non-randomised comparative studies assessing various surgical procedures (3571 participants) and 15 case series on the use of collagenase (3154 participants).An economic model was developed to estimate the costs and consequences of CCH versus alternative surgical procedures. The current NICE guidance (TA459, published July 2017) recommends CCH as an option for treating Dupuytren’s contracture with a palpable cord in adults only if all the following apply:
• There is evidence of moderate disease (functional problems and metacarpophalangeal joint contracture of 30° to 60° and proximal interphalangeal joint contracture of less than 30° or first web contracture) plus up to two infected joints.
• Percutaneous needle fasciotomy is not considered appropriate, but limited fasciectomy is considered appropriate by the treating hand surgeon.
• The choice of treatment (CCH or limited fasciectomy) is made on an individual basis after discussion between the responsible hand surgeon and the patient about the risks and benefits of the treatments available.
• One injection is given per treatment session by a hand surgeon in an outpatient setting.
Miriam Brazzelli; email@example.com
Brazzelli, M, Cruickshank, M, Tassie, E, McNamee, P, Robertson, C, Elders, A, Fraser, C, Hernandez, R, Lawrie, D, Ramsay, CR Collagenase clostridium histolyticum for the treatment of Dupuytren's contracture: systematic review and economic evaluation Health Technol Assess 2015;19(90)