Changes in Provider Treatment Patterns for Dupuytren's Contracture: Analysis of Trends in Medicare Beneficiaries

Background: Collagenase Clostridium histolyticum (CCH) injection has been shown to be a safe and effective treatment option for Dupuytren's contracture. We hypothesize that the gaining popularity of CCH has resulted in a change in treatment patterns among providers, with increased utilization of CCH injections in the management of Dupuytren's contracture from 2012 to 2014. Methods: The Medicare Provider Utilization and Payment Data Public Use Files were used to identify all surgeons who submitted claims for surgical fasciectomy, needle aponeurotomy (NA), and CCH injection. The data were analyzed for number of providers performing the procedures, number of procedures per provider, and location of practice. Results: From 2012 to 2014, the number of providers performing more than 10 open fasciectomies decreased from 141 to 131. In the same time, the number of providers performing more than 10 NAs increased from 63 to 70 with mean procedures per provider decreasing from 35 to 21. In contrast, the number of providers performing more than 10 CCH injections increased from 72 to 112, with mean injections per provider going from 24 to 20. The total number of injections performed increased from 1,734 to 2,220 from 2012 to 2014. The largest increase in number of injections and number of providers performing injections occurred in the South. Conclusions: The introduction of collagenase has changed treatment patterns with more providers treating Dupuytren's contractures with CCH injections and a statistically significant decline in the number of NA procedures per provider.