Peyronie's disease: the impact of collagenase clostridium histolyticum on diagnosis, treatment, and cost
Peyronie's disease (PD) is characterized by fibrous penile plaque formation that interferes with sexual function and quality of life. Many treatments have been proposed, the most recent being collagenase clostridium histolyticum (CCH) injections (FDA approved in 2014). Currently only verapamil, CCH, and surgical approaches are recommended by AUA guidelines. Given mixed evidence for efficacy of verapamil, invasive nature of surgery, and novel mechanism of CCH, there is significant interest in CCH use. We sought to evaluate the impact of CCH on the prevalence, treatment, and cost of PD.
Optum is a national database with information from adjudicated and paid insurance claims of privately-insured individuals, covering between 6 and 7 million males from 2004 to 2016. We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6) and treatments. Both individual years and eras before and after CCH use (2004-2013 vs 2015-2016) were analyzed for prevalence of PD, overall rate of PD treatment, rate of penile injections, rate of CCH use, rate of surgical PD procedures, and cost associated with treatment. Analyses were conducted using SAS (version 9.3).
The annual prevalence of PD rose from 0.03% in 2004 to 0.08% in 2011 and remained stable thereafter. Among men >50, the prevalence remained between 13-14% after 2011. However, annual rates of PD treatment increased from an average of 11.1% for 2004-2013 to a high of 14.8% in 2015. Corresponding to this, annual penile injection rates increased from an average of 5.5% from 2004-2013 to 9.5% for 2015-2016. By 2016, CCH was 74.9% of all penile injections. Average annual rates of penile plication (3.3% vs 3.4%), penile grafting (1.0% vs 0.51%), and penile prosthesis (12.1% vs 12.1%) among men with a PD diagnosis remained stable for the same eras. The average annual cost of PD treatment per man increased from $1824.16 in 2004 to $4010.92 in 2016 (inflation adjusted). This was most pronounced from 2013 to 2016 where an average increase of $361.41 per year was observed, versus $122.50 for the years prior.
The prevalence of PD stabilized in 2011 and did not increase after CCH became available in 2014. Over the same period, the proportion of men receiving treatment for PD increased, associated with more injections and CCH use. In addition, the cost of treating PD increased more rapidly after CCH became available. Further research into CCH use is needed to assess if the increase in treatment has improved outcomes of men with PD.