Wu, Qi orcid.org/0000-0002-8281-7799, Arundel, Catherine orcid.org/0000-0003-0512-4339, Welch, Charlie orcid.org/0000-0002-2421-5538 et al. (4 more authors) (Accepted: 2025) The Cost-Effectiveness of Collagenase Injection versus Limited Fasciectomy for Moderate Dupuytren’s Contracture: An Economic Evaluation of the DISC Trial and a Decision Analytical Model. Value in Health. ISSN: 1524-4733 (In Press)
Abstract
Objectives: To compare the cost-effectiveness of collagenase injection (collagenase) and limited fasciectomy (LF) surgery in treating moderate Dupuytren’s contracture (DC) in the UK over different time horizons. Methods: An incremental cost-effectiveness analysis was conducted alongside a multicentre, pragmatic, parallel randomised controlled trial (DISC), to determine the short-term cost-effectiveness of collagenase compared to LF. A Markov decision analytic model was developed to assess long-term cost-effectiveness. Results: Collagenase was associated with significantly lower cost and insignificantly lower Quality-adjusted life year (QALY) gain compared to LF at one year. The probability of collagenase being cost-effective was over 99% at willingness-to-pay thresholds of £20,000–£30,000 per QALY. At two years, collagenase was both significantly less costly and less effective compared to LF, and LF became cost-effective above a threshold of £25,488. There was a high level of uncertainty surrounding the 2-year results. Over a lifetime horizon, collagenase generated a cost saving of £2,968 per patient, but was associated with a mean QALY loss of -0.484. The probability of collagenase being cost-effective dropped to 22% and 16% at £20,000–£30,000 per QALY, respectively. Conclusions: Collagenase was less costly and less effective than LF in treating DC. The cost-effectiveness of collagenase compared to LF was time-dependent. Collagenase was highly cost-effective one-year post-treatment, but the probability of collagenase being cost-effective declined over time. The Markov model suggested that LF is more cost-effective over a lifetime horizon. These findings emphasise the importance of longer follow-up when comparing surgical and nonsurgical interventions to fully capture overall costs and benefits. Keywords: Dupuytren’s contracture, Collagenase clostridium histolyticum, limited fasciectomy, cost-effectiveness, Markov model
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | This is an author-produced version of the published paper. Uploaded in accordance with the University’s Research Publications and Open Access policy. |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) |
Funding Information: | Funder Grant number NETSCC 15/102/04 |
Depositing User: | Pure (York) |
Date Deposited: | 07 Aug 2025 16:10 |
Last Modified: | 07 Aug 2025 16:10 |
Status: | In Press |
Refereed: | Yes |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:230208 |
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