Treatment Trends and Cost Associated with Peyronie’s Disease
Treatments for Peyronie's Disease (PD) include oral, injectable, and surgical therapies. In December 2013, the Food and Drug Administration (FDA) approved collagenase clostridium histolyticum (Xiaflex®) as the first pharmacologic treatment for PD. The purpose of this study was to characterize trends in PD treatment over time and associated costs utilizing a large, commercial insurance claims database.
The Truven MarketScan® database was queried from 2007-2015 for men with PD identified by ICD-9 code. Six months of enrollment were required. Oral therapies included pentoxifylline, colchicine, and tamoxifen, which were identified by National Drug Code (NDC). Injectable therapies included interferon alpha-2B, verapamil, and Xiaflex®, which were identified by Current Procedure Terminology (CPT) code, J code, and NDC code. Surgical therapies were identified by CPT code and included penile plication, excision of penile plaque with or without grafting, and penile prosthesis. Cost is the gross payment measure attributed to specific PD treatments exclusive of non-specific PD claim codes (e.g. office visit).
72,039 individuals were identified with PD. The percent annual prevalence of PD rose from 0.06% to 0.1% over the included years, and the percent annual treatment rate rose from 17.8% to 27.6%. Colchicine was the most commonly prescribed oral agent in 2007 (69.7%); by 2015, pentoxifylline comprised 72.3% of oral treatments. In 2007, 98.4% of injections were intralesional verapamil. By 2015, 82% of injections were Xiaflex® while 17.7% were verapamil. Penile plication was the most common procedure from 2007-2015, comprising approximately 50% of all surgeries. Mean annual, per-individual cost of PD treatment increased from $1,311.58 in 2007 to $7,310.48 in 2015 (Figure 1).
Diagnosis and treatment of PD is increasing over time. Pentoxifylline replaced colchicine as the most common oral agent during the study period, while Xiaflex® replaced verapamil injections. The cost associated with PD treatment rose over five-fold from 2007 to 2015 and corresponds with FDA approval of Xiaflex®. Further studies should assess if quality of life improvement and functional outcomes justify this added cost.