Fitzpatrick Alanna Victoria, Moltaji Syena, Ramji Maleka, Martin Stuart
Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada.
Plast Surg (Oakv). 2021 Nov;29(4):257-264. doi: 10.1177/2292550320963111. Epub 2020 Oct 16.
Surgeons now have a variety of treatment options for Dupuytren's contracture including traditional partial fasciectomy (PF), percutaneous needle aponeurotomy (PNA), and collagenase (CCH) injection. An important factor in clinical decision making is the cost-effectiveness of the various modalities, as will be discussed in this article.
A literature search was performed by 2 independent reviewers. A total of 14 articles and 3 abstracts met inclusion criteria. Papers were excluded for non-English language, insufficient breakdown of costs by treatment type, promotional materials, or works-in-progress. Cost data were extracted and subsequently converted to US dollars. Weighted means were used to objectively pool data that were sufficiently similar in methodology and population.
Seven observational cohort studies were pooled and found to have a weighted mean cost in favour of PNA at US$3335 per patient as compared to CCH at US$3673.14 and PF at US$4734.14. Two expected-value decision analysis models were in agreement that PF is not cost-effective, but they differed on whether PNA or CCH was the most cost-effective strategy. Two cost minimization studies agreed that CCH was less costly than PF by US$486. One cost-benefit analysis found no significant cost benefit to CCH or PF, but found significant indirect benefit to CCH. Overall 10 of 17 studies found CCH to be superior with respect to direct cost, indirect cost, or both. Only 2 of the 17 studies found PF to be the most cost-effective method. Of the 7 studies that considered PNA, 4 found it to be lowest cost.
The vast majority of studies found PF to be the most costly treatment modality; however, it is still the treatment of choice in certain clinical scenarios. It is difficult to compare CCH to PNA, as many studies did not consider PNA. More studies, especially considering indirect costs, are required to be able to accurately determine which method is most cost-effective.
外科医生目前对于杜普伊特伦挛缩症有多种治疗选择，包括传统的部分筋膜切除术（PF）、经皮针状腱膜切开术（PNA）和胶原酶（CCH）注射。如本文所讨论的，临床决策中的一个重要因素是各种治疗方式的成本效益。
由2名独立评审员进行文献检索。共有14篇文章和3篇摘要符合纳入标准。因非英语语言、未按治疗类型充分细分成本、宣传材料或正在进行的研究而排除相关论文。提取成本数据，随后换算为美元。采用加权均值客观汇总在方法和人群方面足够相似的数据。
汇总了7项观察性队列研究，发现加权平均成本显示，每名患者采用PNA的成本为3335美元，优于采用CCH的3673.14美元和采用PF的4734.14美元。两项期望值决策分析模型一致认为PF不具有成本效益，但在PNA还是CCH是最具成本效益的策略上存在分歧。两项成本最小化研究一致认为CCH比PF成本低486美元。一项成本效益分析发现CCH或PF没有显著的成本效益，但发现CCH有显著的间接效益。总体而言，17项研究中有10项发现CCH在直接成本、间接成本或两者方面更具优势。17项研究中只有2项发现PF是最具成本效益的方法。在考虑PNA的7项研究中，4项发现其成本最低。
绝大多数研究发现PF是成本最高的治疗方式；然而，在某些临床情况下它仍是首选治疗方法。由于许多研究未考虑PNA，因此难以将CCH与PNA进行比较。需要更多研究，尤其是考虑间接成本的研究，以便能够准确确定哪种方法最具成本效益。
