Operative trends and physician treatment costs associated with Dupuytren’s disease in Canada

Dupuytren’s disease (DD) is a fibroproliferative disease of the palmar fascia that, through the formation of palmar nodules and fibrous cords, can lead to disabling flexion contractures of the fingers (1,2). DD has been reported to have a global prevalence of 3% (3,4), with the highest prevalence in Northern Europe (5,6). Prevalence increases with age, and males are more commonly affected than females (7,8). Up to 40% of men ≥70 years of age in parts of northern Europe are affected by DD (7,9). Currently, the gold standard of treatment for DD is surgical or open fasciectomy, although closed fasciotomy (also known as percutaneous needle fasciotomy or needle aponeurotomy), and collagenase enzymatic digestion of disease cords are being advocated as nonsurgical alternatives (10,11). Because of the high cost differential in these treatment methods, we were interested in documenting the treatment trends and health care expenditures associated with DD in Canada. The current study provides an analysis of both inpatient and day-surgery treatment for DD, and includes a description of treatment trends. Unlike other countries, such as France and England, Canada does not have a system of assigning health care expenditures to a specific diagnosis-related group. Instead, it has a system of global funding that roughly assigns funding based on population. Attempts to estimate the costs of treatment for a specific disease in Canada are, therefore, significantly more difficult. We were, however, able to estimate the physician reimbursement costs in Ontario for the management of DD.