Urology Department, Stepping Hill Hospital, Stockport NHS Foundation Trust, Poplar Grove, UK.
Urology Department, Manchester Royal Infirmary, Manchester University Hospitals Foundation Trust, Manchester, UK.
Andrology. 2020 Sep;8(5):1304-1311. doi: 10.1111/andr.12830. Epub 2020 Jun 27.
Collagenase clostridium histolyticum is a recognized non-surgical management for Peyronie's disease, licenced for use in the UK for patients with a palpable plaque and a curvature deformity of at least 30°. However, it is not currently funded for use within the National Health Service. Collagenase clostridium histolyticum has also recently been withdrawn from the European and other markets worldwide, but there is potential for this to be produced off-patent in the future.
To determine whether collagenase clostridium histolyticum is cost-neutral when compared to surgical management within a public health care system, using the National Health Service as an example.
Two published protocols for the administration of collagenase in Peyronie's disease were identified-the 'IMPRESS protocol' and the 'London protocol'. Costs were taken from published NHS literature. Surgical intervention rates after collagenase clostridium histolyticum administration and primary penile plication were taken from published literature. The costs of the two published protocols were calculated with costs of any repeat surgical intervention were included within each protocol per patient cost.
At the current cost per vial of collagenase to the National Health Service, the IMPRESS protocol per patient costs £3,832.77 (143.7%) more than primary surgery, whilst the London protocol costs £70.77 (2.7%) more than primary surgery.
At a cost of £548.41 per vial, collagenase administered under the London protocol would be a management option for Peyronie's disease cost neutral to primary corrective surgery.
Central funding of collagenase in a public healthcare system would enable the management of Peyronie's disease to be moved to the outpatient setting. For this to be done at no additional cost to the NHS, it would require a cost reduction per vial of collagenase of £23.59 (4.1%), to a cost of £548.41.
胶原酶溶组织梭菌是一种公认的非手术治疗方法，用于治疗可触及斑块且弯曲畸形至少 30°的 Peyronie 病，在英国获得许可使用。然而，目前国民保健制度尚未为其提供资金。胶原酶溶组织梭菌最近已在欧洲和其他国家/地区撤出市场，但未来有可能在专利期外生产。
以国民保健制度为例，确定在公共医疗保健系统中，与手术治疗相比，胶原酶溶组织梭菌是否具有成本中性。
确定了两种用于治疗 Peyronie 病的胶原酶管理方案——“IMPRESS 方案”和“伦敦方案”。从英国国民保健制度公布的文献中获取成本。从公布的文献中获取胶原酶溶组织梭菌给药后的手术干预率和原发性阴茎折叠术。计算了两种方案的成本，并在每个方案的每位患者成本中纳入了任何重复手术干预的成本。
按国民保健制度目前每支胶原酶的成本计算，IMPRESS 方案每位患者的成本比原发性手术高出 3832.77 英镑（143.7%），而伦敦方案比原发性手术高出 70.77 英镑（2.7%）。
按照每支 548.41 英镑的价格，在伦敦方案下使用胶原酶将成为 Peyronie 病的一种管理选择，与原发性矫正手术相比具有成本中性。
在公共医疗保健系统中对胶原酶进行中央资金资助将使 Peyronie 病的管理能够转移到门诊环境。要做到这一点，不对国民保健制度增加成本，需要将每支胶原酶的成本降低 23.59 英镑（4.1%），降至 548.41 英镑。
