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.