Trends in Treatment and Reimbursement of Dupuytren Disease

Dupuytren disease (DD) is a fibroproliferative disorder that can result in progressive hand contractures and functional impairment. Multiple treatment options are available, ranging from minimally invasive procedures to surgical interventions. Current long-term trends in treatment utilization and reimbursement remain incompletely characterized. Understanding these trends is essential for clinical decision-making and resource allocation.

A retrospective longitudinal analysis was conducted using Medicare data from 2005 to 2024. Treatment utilization and reimbursement data were extracted for current procedural terminology codes corresponding to percutaneous needle fasciotomy (PNF), open fasciotomy, collagenase Clostridium histolyticum injection (CCH) with manipulation, and fasciectomy-based procedures. Annual procedure volumes were normalized to Medicare enrollment. Reimbursement values were adjusted for inflation using the US Consumer Price Index. Temporal trends were assessed using the 2-tailed Mann-Kendall trend test.

Utilization of surgical procedures declined significantly over the study period, whereas PNF and CCH demonstrated no individual temporal trends. When grouped as minimally invasive procedures, PNF and CCH showed an overall increase in utilization. A transient decline in utilization across all procedures occurred in 2020, followed by partial recovery in subsequent years. Normalized annual procedure volumes for DD demonstrated no significant temporal trend. Inflation-adjusted Medicare reimbursement per service declined significantly by 38% over the study period; fasciectomy-based procedures remained the highest reimbursed interventions and showed no significant temporal change. In contrast, reimbursement for PNF and CCH declined significantly over time.

Over the past 2 decades, minimally invasive treatment of DD has become more common, whereas fasciectomy has been declining. Nevertheless, fasciectomy remains the most commonly performed treatment for DD. Decreasing inflation-adjusted reimbursement highlights growing economic pressures on health care and providers.

Economic decision and analysis IV.