Walton Eric L, Quinn Timothy P, Mulloy Evan, Patil Dattatraya, Mehta Akanksha
Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.
Sex Med. 2022 Jun;10(3):100517. doi: 10.1016/j.esxm.2022.100517. Epub 2022 Apr 21.
Collagenase Clostridium histolyticum (CCH), which was approved by the FDA for the treatment of Peyronie's disease (PD) in 2013, may obviate the need for surgery but its historically high cost must be considered when offering CCH vs surgical intervention to affected patients.
To compare trends of intralesional injections vs surgical treatment for PD and assess the contemporary cost of treatment with CCH vs surgical intervention.
We reviewed 2009-2019 MarketScan Commercial Claims data to identify all men 18 years and older with PD. CPT and HCPCS codes were used to identify PD treatments for each patient. Associated insurance claims in USD were summed for each treatment type.
Total and out-of-pocket costs, as well as frequencies, for treatments were calculated on a yearly basis and the Cochran-Armitage test was used to compare frequencies before and after FDA approval of CCH.
Of 89,205 men diagnosed with PD, 21,605 (24.2%) underwent treatment; most required only intralesional injections, however 1,519 (7.0%) received only surgical therapy and 1,951 (9.0%) required medical and surgical therapy. Intralesional CCH use sharply increased after its FDA-approval in 2013 with a concomitant fall of intralesional verapamil use. The use of both surgical plication and plaque grafting decreased steadily from 2009 to 2019. The median cost per patient for all 3 treatments increased over the study time-period: $1,856 to $3,196 for plication, $2,233 to $3,631 for plaque grafting, and $6,940 to $8,895 per cycle for CCH. Out-of-pocket median patient contribution for plication, plaque grafting, and per cycle intralesional CCH injection were similar over the study period and never exceeded $300.
CCH is significantly more expensive than any surgical treatment option, however, the out-of-pocket patient contribution for surgery and CCH are similar.
STRENGTHS & LIMITATIONS: This study incorporated all procedure costs and is the most contemporary, comprehensive, and accurate reflection of overall and out-of-pocket costs to patients for surgical and intralesional PD therapies. We anticipate these data to allow for a more complete discussion between patients and providers regarding their care. The use of a commercial claims database prohibited assessment of post-procedural costs and treatment outcomes.
CCH use has increased significantly since its FDA approval in 2013 with out-of-pocket patient contribution comparable to surgical therapy despite significantly higher total treatment costs. Walton EL, Quinn TP, Mulloy E, et al. Cost of Intralesional Collagenase Clostridium Histiolyticum Therapy Versus Surgery for the Management of Peyronie's Disease: A Claims-Based Analysis (2009-2019). Sex Med 2022;10:100517.
溶组织梭状芽孢杆菌胶原酶（CCH）于2013年获美国食品药品监督管理局（FDA）批准用于治疗佩罗尼氏病（PD），它可能无需进行手术，但在为受影响患者提供CCH治疗与手术干预时，必须考虑其历来高昂的成本。
比较PD病灶内注射与手术治疗的趋势，并评估CCH治疗与手术干预的当代成本。
我们回顾了2009 - 2019年市场扫描商业索赔数据，以确定所有18岁及以上患有PD的男性。使用现行程序编码（CPT）和医疗保健通用程序编码系统（HCPCS）代码来确定每位患者的PD治疗方法。汇总每种治疗类型的相关保险索赔金额（以美元计）。
在89,205名被诊断为PD的男性中，21,605名（24.2%）接受了治疗；大多数仅需要病灶内注射，然而，1,519名（7.0%）仅接受了手术治疗，1,951名（9.0%）需要药物和手术治疗。2013年CCH获FDA批准后，病灶内CCH的使用急剧增加，同时病灶内维拉帕米的使用量下降。从2009年到2019年，手术折叠和斑块移植的使用量稳步下降。在研究期间，所有三种治疗的每位患者中位成本均有所增加：手术折叠从1,856美元增至3,196美元，斑块移植从2,233美元增至3,631美元，CCH每个周期从6,940美元增至8,895美元。在研究期间，患者自付的手术折叠、斑块移植和每个周期病灶内CCH注射的中位费用相似，且从未超过300美元。
CCH比任何手术治疗方案都要昂贵得多，然而，患者自付的手术和CCH费用相似。
本研究纳入了所有手术费用，是对患者手术和病灶内PD治疗的总体和自付费用最具时效性、全面性和准确性的反映。我们预计这些数据将使患者和医疗服务提供者能够就他们的治疗进行更全面的讨论。使用商业索赔数据库禁止评估术后成本和治疗结果。
自2013年获FDA批准以来，CCH的使用显著增加，尽管总治疗成本显著更高，但患者自付费用与手术治疗相当。沃尔顿·E·L、奎因·T·P、马洛伊·E等。溶组织梭状芽孢杆菌胶原酶病灶内治疗与手术治疗佩罗尼氏病的成本：基于索赔的分析（2009 - 2019年）。性医学2022；10：100517。
