Healthcare Costs and Resource Use of Patients with Dupuytren Contracture Treated with Collagenase Clostridium Histolyticum or Fasciectomy: A Propensity Matching Analysis

Figures & data

Table 1 Baseline Demographic and Clinical Characteristics for Unmatched Cohorts

Parameter	CCH (n=953)	Fasciectomy (n =1932)	P-value
Age, y, mean (SD)	56.8 (5.6)	56.0 (6.5)	0.001
Age range, y	32–64	20–64	–
>50 years, n (%)	836 (87.7)	1611 (83.4)	0.002
Males, n (%)	782 (82.1)	1316 (68.1)	<0.001
Geographic region, n (%)
Northeast	223 (23.4)	345 (17.9)	<0.001
North Central	184 (19.3)	473 (24.5)	0.002
South	373 (39.1)	732 (37.9)	0.52
West	171 (17.9)	368 (19.0)	0.47
Unknown	2 (0.2)	14 (0.7)	0.11
Payer type, n (%)
Preferred provider organization	597 (62.6)	1143 (59.2)	0.07
Consumer-driven health plan	99 (10.4)	232 (12.0)	0.20
Health maintenance organization	80 (8.4)	182 (9.4)	0.37
Non-capitated point-of-service plan	69 (7.2)	114 (5.9)	0.16
High-deductible health plan	56 (5.9)	105 (5.4)	0.63
Other*	52 (5.5)	156 (8.1)	0.01
CCI score, mean (SD)^†	0.72 (1.27)	0.84 (1.40)	0.02
DC-associated risk factor comorbid condition, n (%)
Hypertension	402 (42.2)	877 (45.4)	0.10
Hyperlipidemia	390 (40.9)	857 (44.4)	0.08
Tobacco use disorder	73 (7.7)	208 (10.8)	0.008
Trigger finger syndrome	52 (5.5)	336 (17.4)	<0.001
Gout	39 (4.1)	75 (3.9)	0.78
Carpal tunnel syndrome	34 (3.6)	217 (11.2)	<0.001
Alcohol use	25 (2.6)	56 (2.9)	0.67
Complex regional pain syndrome	0 (0.0)	3 (0.2)	0.56
Epilepsy	5 (0.5)	16 (0.8)	0.49

Notes: *Comprehensive, exclusive provider organization, point-of-service with capitation, or unknown. ^†Comorbidities were assessed during the 24-month pre-index period.

Abbreviations: CCH, collagenase clostridium histolyticum; CCI, Charlson Comorbidity Index; DC, Dupuytren contracture.

Figure 1 Study flow.

Abbreviations: CCH, collagenase clostridium histolyticum; DC, Dupuytren contracture.

Table 2 Mean (SD) All-Cause Healthcare Costs During the 12-Month Post-Index Period in Unmatched Cohorts

Cost, US $, Mean (SD)	CCH (n=953)	Fasciectomy (n=1932)	P-value
Outpatient	6894 (9261)	10,601 (12,643)	<0.001
Outpatient prescription	3911 (6569)	2701 (7612)	<0.001
Inpatient	835 (6584)	1817 (12,812)	0.07
Emergency department	257 (1317)	409 (1628)	0.02
Total	11,897 (14,633)	15,528 (22,254)	<0.001

Abbreviation: CCH, collagenase clostridium histolyticum.

Table 3 Healthcare Resource Utilization During the 12-Month Post-Index Period in the Matched Cohorts

Parameter	CCH (n=702)	Fasciectomy (n=999)	P-value
Outpatient medical prescriptions, mean (SD)	16.8 (17.7)	18.3 (20.1)	0.11
Outpatient services, mean (SD)
All-cause outpatient visits	14.4 (12.1)	16.9 (13.6)	<0.001
DC-related outpatient visits	4.8 (4.4)	5.7 (7.4)	0.001
Outpatient visits per patient with service	14.4 (12.1)	16.9 (13.6)	<0.001
Inpatient services
Patients hospitalized, n (%)	16 (2.3)	39 (3.9)	0.06
All-cause hospitalizations, mean (SD)	0.03 (0.22)	0.05 (0.26)	0.08
Duration of hospitalization, days, mean (SD)	0.08 (0.73)	0.16 (1.0)	0.09
DC-related hospitalizations, mean (SD)	0.0 (0.04)	0.0 (0.02)	0.78
Duration of hospitalization, days, mean (SD)	0.0 (0.04)	0.0 (0.05)	0.78
Hospitalizations per patient, mean (SD)	1.2 (0.8)	1.3 (0.5)	0.97
Duration of hospitalization per hospitalized patient, days, mean (SD)	3.7 (3.3)	4.1 (3.4)	0.74
Emergency department visits
Patients with emergency department visits, n (%)	77 (11.0)	112 (11.2)	0.88
All-cause emergency department visits, mean (SD)	0.2 (0.6)	0.2 (0.5)	0.92
DC-related emergency department visits, mean (SD)	0.0 (0.04)	0.0 (0.04)	0.80
Emergency department visits per urgently admitted patient, mean (SD)	1.5 (1.2)	1.4 (0.8)	0.69

Abbreviations: CCH, collagenase clostridium histolyticum; DC, Dupuytren contracture.

Figure 2 Mean (SD) all-cause (A) and DC-related (B) healthcare costs during the post-index period in the matched cohorts.

Abbreviations: CCH, collagenase clostridium histolyticum; DC, Dupuytren contracture.

Table 4 Key Drivers of Total All-Cause Healthcare Costs in Matched Cohorts

Parameter	Adjusted Odds Ratio (95% CI)	P-value
CCH versus fasciectomy	0.90 (0.82–0.94)	<0.001
Age of patient (continuous)	1.01	<0.001
CCI score*
Weight sum 1	1.22 (1.11–1.35)	<0.001
Weight sum 2	1.35 (1.22–1.35)	<0.001
Weight sum 3	2.01 (1.65–2.46)	<0.001
Weight sum ≥4	2.72 (2.01–3.29)	<0.001
Depression or anxiety diagnosis	1.35 (1.22–1.49)	<0.001
Type of insurance plan^†
Consumer-driven health plan	0.82 (0.74–0.94)	0.002
HMO	1.11 (1.01–1.35)	0.03
Non-capitated point-of-service plan	1.22 (1.02–1.35)	0.02

Notes: *Reference: sum of weights = 0. ^†Reference: preferred provider organization.

Abbreviations: CCH, collagenase clostridium histolyticum; CCI, Charlson Comorbidity Index; HMO, health maintenance organization.