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

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 using 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, Open fasciotomy/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, treatment volumes for DC increased by 167%. Over this period, treatment patterns shifted substantially away from surgical management: open fasciectomy accounted for 96% of all procedures in 2000 but declined to 59% in 2021, whereas CCH emerged as a major treatment modality, accounting for 27% of all procedures by 2021. Enrollment-adjusted procedure volumes increased by 468% for percutaneous needle fasciotomy, 19% for CCH, and 2% for open fasciectomy. Inflation-adjusted physician reimbursement declined by 42% across all Dupuytren contracture treatments, with the greatest decrease observed for percutaneous needle fasciotomy (32%) and the smallest for CCH (5%). Public interest, as assessed by Google Trends, increased by 525% for DC-related searches, including a 1,033% increase in searches related to CCH.

CONCLUSIONS: Open surgical treatment volumes remained relatively stable over the study period, whereas the introduction of CCH was associated with increased overall treatment utilization and a reduction in the proportional share of surgical procedures. This shift coincided with substantial growth in public interest in nonsurgical therapies. Concurrent declines in inflation-adjusted reimbursement across all treatments highlight ongoing financial pressures on clinicians, particularly in the context of high-cost therapies such as CCH. Collectively, these findings underscore the importance of evidence-based, value-conscious decision making to ensure that treatment selection is driven by clinical effectiveness and cost-efficiency rather than external influences such as public interest or marketing.

CLINICAL RELEVANCE: Treatment patterns for DC have evolved alongside the introduction of less invasive therapies and increasing public awareness. Understanding how utilization, reimbursement, and public interest intersect is essential for informed, evidence-based decision making in the management of DC.