Peyronie’s Disease (PD) is a fibrotic disorder of the tunica albuginea of the corpora cavernosa and is progressive in nature. Consequently, this disorder is linked to a decrease in sexual performance and self-confidence. Currently, treatments include oral medication, surgical reconstruction, and injectable therapy. The purpose of this study was to compare the costs of treatment with Collagenase Clostridium Histolyticum (CCH), an injectable therapy, and surgery. Also, this study aims to determine if the distribution of PD treatments changed after the FDA approved CCH treatments.

Between 2009 and 2019, a total of 89,205 men were diagnosed with PD. Most of them (50.7%) were diagnosed between the ages of 48 and 60.  46.7% of the men had Erectile Dysfunction (ED), with 38.4% of the men having ED prior to their PD diagnosis. Out of the men diagnosed with PD, 21,605 received some type of therapy. 83.9% of those men received only medical therapy, 7.0% only surgical therapy, and 9.0% received a combination of medical and surgical therapy. When it came to intralesional injections, 20,086 men chose to receive injections with 34.3% of them using CCH only (available since 2014), 63.3% verapamil (much less often since 2014), and 2.0% verapamil and CCH. A total of 3,470 men chose surgical therapy. Plication was the most popular choice with 56.0% of the men choosing that option, followed by plaque incision and grafting at 27.6%.

Regarding intervention cost, the median cost for CCH (per cycle), plication, and plaque incision and grafting increased over the 10 years of the study. Plication went from $1,856 to $3,196, incision and grafting from $2,233 to $3,631, and CCH from $6,940 to $8,895.

The FDA approved the use of CCH in December 2013. Consequently, the use of CCH increased after FDA approval and continued to rise as of 2019 while verapamil injection therapy dropped. Overall, there was an increase in the use of CCH for PD as well as a decrease in the use of surgical therapies during 2009-2019. Over 90% of the patients that were treated for PD in this study received intralesional therapy. Since 2014, CCH ranked as the most expensive PD treatment with a cost of around $6,000-$9,000 per cycle making a total cost of $15,000-$20,000 (median of 2 cycles). On the other hand, the annual cost for any surgical therapy was around $2,000-$5,000. Even though the cost for treatment options increased between 2014 and 2019, the out-of-pocket patient contributions did not change significantly. Per cycle of CCH, the median contribution was $100-$300 (total of $300-$800 per patient). For surgery, the patient contribution was $150-$500.

In summary, the use of CCH injections increased sharply after its approval by the FDA (despite the greater cost compared to surgery), while the use of verapamil injections and surgery decreased. Overall, CCH is less invasive than surgery, and although the total costs to the healthcare system are higher for CCH, patient out of pocket costs are similar to surgery.

It is important to note that costs for the actual procedures, may not be the only “costs” paid by the patient when all is said and done. In a study done by our team, we found that while CCH was associated with a higher cost initially, when intermediate costs and quality-adjusted life years (QALY’s) related to morbidity were taken into account, surgery was not the most cost-effective method.  Although there were several contributors, this was largely due to the fact that erectile dysfunction rates were higher after surgery for PD.  The cost to treat this and impact on quality of life years resulted in the true costs of therapy being similar between CCH and surgery. 

Despite the financial considerations, the take home message is that ultimately, patient desires are most important.  Every patient will have different goals and desired outcomes, and the specific therapy selected must be tailored to meet those goals. 

References

1. Walton, E.L., Quinn, T.P., Mulloy, E., Patil, D., and Mehta, A. (2022). Cost of Intralesional Collagenase Clostridium Histolyticum Therapy Versus Surgery for the Management of Peyronie’s Disease: A Claims-Based Analysis (2009-2019). Sexual Medicine, 10(3), 100517. DOI: 10.1016/j.esxm.2022.100517

https://pubmed.ncbi.nlm.nih.gov/35461065/

2. Wymer, K., Kohler, T., and Trost, L. (2019). Comparative Cost-effectiveness of Surgery, Collagenase Clostridium Histolyticum, and Penile Traction Therapy in Men with Peyronie’s Disease in an Era of Effective Clinical Treatment. The Journal of Sexual Medicine, 16(9), 1421-1432. DOI: 10.1016/j.jsxm.2019.06.010

https://pubmed.ncbi.nlm.nih.gov/31351851/