Superior Cost Effectiveness Of Penile Plication Versus Intralesional Collagenase Injection For Treatment Of Peyronie'S Disease Deformities

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie’s Disease1 Apr 2016PD45-06 SUPERIOR COST EFFECTIVENESS OF PENILE PLICATION VERSUS INTRALESIONAL COLLAGENASE INJECTION FOR TREATMENT OF PEYRONIE’S DISEASE DEFORMITIES Billy Cordon, Ryan Hutchinson, Matthias Hofer, Gregory Broderick, Yair Lotan, and Allen Morey Billy CordonBilly Cordon More articles by this author , Ryan HutchinsonRyan Hutchinson More articles by this author , Matthias HoferMatthias Hofer More articles by this author , Gregory BroderickGregory Broderick More articles by this author , Yair LotanYair Lotan More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2106AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2013 injection of clostridium histolyticum collagenase (Xiaflex®, Auxilium) became the first non-surgical FDA approved treatment for men with Peyronie's. We evaluated cost effectiveness of Xiaflex injection compared to penile plication. METHODS We developed a decision tree model using TreeAge Pro® cost analysis software, comparing collagenase therapy vs penile plication. We defined success as <30°. Published literature (including the IMPRESS I & II trials) regarding curvature improvement was used to calculate the probability of success of injection stratified by severity of disease, moderate 30-60°, and severe 61-90°. Using 33.8% improvement in curvature for 30-60°, calculated success probability is 45.9%, failure 54.1%. For 61-90° with a reported 35% improvement, calculated success probability is 11.9%, failure 88.1%. We assume 50% of injection failures proceed to secondary plication. Cost of 7.2 injections was used, the average injections per patient in the pooled safety analysis. Costs of medications, office visits, facility and surgical fees and predicted costs of complications were averaged from multiple institutions. For penile plication, 90% success was used based on published rates for all severity. All failed plications were assumed to undergo repeat plication. RESULTS Per patient plication cost was $2,763 and injection cost $25,159. Plication pathway was $2,818 versus injection pathway for moderate ($25,875), and severe ($26,429) disease. One-way sensitivity analyses cost equivalency was $2,102 for injection. No increase in efficacy of collagenase accomplished cost-equivalence. Two-way sensitivity analyses for injection cost versus plication cost, and injection success versus injection cost are shown (Figure 1). CONCLUSIONS Xiaflex treatment was 9-fold more expensive than penile plication. Achieving cost equivalency would require a significant decrease in management cost for collagenase, which is largely comprised of drug cost. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1062-e1063 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Billy Cordon More articles by this author Ryan Hutchinson More articles by this author Matthias Hofer More articles by this author Gregory Broderick More articles by this author Yair Lotan More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...