Reflections on cost-effectiveness of colagenase in the treatment of Peyronie's Didease in a public system
Conde Redonde, C1; Castroviejo Royo, F; Garcia Vina, A; Pozas, M; Miralles Ayuso, S; Gonzalez Montesinos, M; Amon Sesmero, JH
1: SACYL, Spain
Introduction: The use of Collagenase from Clostridium Histoliticum for the treatment of Peyronie's disease with palpable plaque has been approved in 2015. The indication is curvature with palpable plaque with curvature> 30 º. The goal is to achieve collagen lysis. We want to evaluate this treatment from the cost-effectiveness point of view in a public health system
Material and Methods: 10 patients with Peyronie disease and a mean follow-up of 12 months have been treated with Xiapex injections, with 0.58 mg and a volume of 0.25 ml. They have been subjected to two cycles of treatment consisting of two injections and a penile modeling with an interval of 7 days between them and 6 weeks between each cycle. After that they are urged to use a penile extender for at least two hours a day for three months. Average age 59.5, middle dorsal curvature 46 degrees (40-60º), average of the plate 2x1 cm, previous pain: 20%, Erectil dysfunction 10%, Penetration capacity 60%, only one patient presents mild ED, previous penile length 6.5cm. Quality measures with IIEF and VAS (Satisfaction index)
Results: All patients have completed two cycles. 50% have not used the Penile extender. Success rate,( residual curvature <15º): 33%. Mean residual curvature (failure) is 50 º, ED 0, satisfaction index 4.2 / 10. 3 Patients needed curvature surgery. Complications: great penile hematoma that suspends the last injection and modeling, cramps and tremors in lower extremities, abandonment by diagnosis of pancreatic cancer. Consultations used in the two cycles: 8. Operating room used: 2 Expenses calculated from xiapex treatment € 3950, expenses calculated in conventional EP surgery: € 2200, excess cost per patient € 1750.
Conclusion: The literature gives a success rate at the plication of cc 63-80%. In the worst case (63%), we achieved double the success with the plication with half the expenses, without counting the waste of seeing the same patient in consultation 8 times (compared to two of the plication) in a given timeframe. of 12 weeks. This implies an opportunity cost of 8/2, which means that we would treat 4 patients by the traditional technique for each treated with Xiapex. To be able to extrapolate these results, it is necessary to carry out a randomized prostective study.
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