Cost evaluation of collagenase clostridium histolyticum versus surgery for dupuytren's contracture

Abstract

Objective: To evaluate whether collagenase injections would be a cost-effective alternative to surgery for Dupuytren’s contracture in Malta. Method: An average of fifty patients per year requires surgery to correct Dupuytren’s contracture in Malta. The price of collagenase injections was obtained from published pharmacoeconomic studies in Spain, United Kingdom and United States. The cost to treat multiple affected joints using collagenase injections at the different prices was compared to the costs associated with surgery in both the government and private hospital setting. A proposed price at which collagenase injections would be more costeffective than surgery to treat two affected joints in Malta was calculated. Key findings: The cost of surgery in the private hospital setting is significantly higher than that in the government hospital setting. The price of collagenase in the United States is significantly higher than in Europe. At the prices available in Europe, collagenase use in Malta would not confer significantly increased costs when treating one, two or three affected joints, both in the government and private hospital setting. Treating two affected joints rather than one affected joint does not significantly increase costs, however treating three affected joints significantly increases costs, in both hospital settings. For collagenase injections to be cost-effective in Malta, they would need to be priced at 77 Euro per vial or less. Conclusion: If all patients were to be administered the injection instead of undergoing surgery, the hospital would be able to accommodate 20 additional total knee replacements each year. With surgery costs in Malta being much less than in other European countries, there could be a possibility for Malta to attract patients from other countries. Collagenase injections would offer a less invasive treatment for the patients, and if priced at 77 Euro per vial or less, would provide a more cost-effective option to the government hospital.