The Impact of Emerging Therapies and Declining Physician Reimbursement on Dupuytren Disease Treatment: A 21-Year Review.

Abstract

Purpose: This study aimed to evaluate the trends in treatment and physician reimbursement for Dupuytren contracture (DC) within the Medicare population over a 21-year period, with a focus on how the introduction of collagenase clostridium histolyticum (CCH) has affected treatment patterns. Additionally, this study examines public interest in DC treatments through Google search trends.

Methods: Medicare Part B data from 2000 to 2021 were analyzed to assess procedure volumes, charges, and reimbursements using Current Procedural Terminology codes for percutaneous needle fasciotomy (PNF), open fasciectomy, and CCH injection. Inflation-adjusted reimbursement rates were calculated. Google Trends data from 2012 to 2023 were analyzed to assess public interest in DC and its treatments.

Results: From 2000 to 2021, DC treatment volumes increased by 468%, with CCH becoming the most widely used treatment, accounting for 61% of all procedures in 2021. PNF increased by 468%, whereas open fasciectomy decreased by 39%. Reimbursement for all DC treatments declined by 18% after inflation adjustment, with the greatest decline in PNF (32%) and the smallest in CCH (5%). Public interest, as measured by Google Trends, demonstrated a 525% increase in searches related to DC, with a 1,033% rise for CCH.

Conclusions: The introduction of CCH has led to a considerable increase in the treatment of DC, possibly driven in part by rising public awareness of emerging therapies. Furthermore, the declining reimbursement rates for all procedures underscore the financial challenges faced by clinicians, particularly given the high cost of treatments like CCH.

Clinical relevance: The growing use of CCH as the dominant treatment for DC underscores how marketing and public awareness may influence treatment practices. Physicians have a responsibility to understand these influences, ensuring that treatment decisions are guided by clinical efficacy and cost-effectiveness while managing patient expectations and prioritizing long-term outcomes over trends driven by marketing.