{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:52:02Z","timestamp":1787021522852,"version":"build-2736575974"},"reference-count":33,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"8","license":[{"start":{"date-parts":[[2013,8,1]],"date-time":"2013-08-01T00:00:00Z","timestamp":1375315200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:p>In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren\u2019s contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren\u2019s contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren\u2019s contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000\/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively.<\/jats:p>\n                  <jats:p>In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren\u2019s contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.<\/jats:p>\n                  <jats:p>Cite this article: Bone Joint J 2013;95-B:1094\u20131100.<\/jats:p>","DOI":"10.1302\/0301-620x.95b8.31822","type":"journal-article","created":{"date-parts":[[2013,8,1]],"date-time":"2013-08-01T05:17:21Z","timestamp":1375334241000},"page":"1094-1100","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":64,"title":["Cost-effectiveness in the management of Dupuytren\u2019s contracture"],"prefix":"10.1302","volume":"95-B","author":[{"given":"H.","family":"Baltzer","sequence":"first","affiliation":[{"name":"Sunnybrook Health Sciences Centre, 2075\rBayview Avenue, M1-525b, Toronto, Ontario\rM4N 3M5, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. A.","family":"Binhammer","sequence":"additional","affiliation":[{"name":"Sunnybrook Health Sciences Centre, 2075\rBayview Avenue, M1-525b, Toronto, Ontario\rM4N 3M5, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1016\/S0266-7681(03)00013-5"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2011.03.002"},{"key":"r3","unstructured":"National Institute for Health and Clinical Excellence (NICE).\n                      NICE Interventional procedures overview of needle fasciotomy for Dupuytren\u2019s contracture. http:\/\/www.nice.org.uk\/nicemedia\/pdf\/ip\/177overview.pdf (date last accessed 31 May 2013)."},{"key":"r4","unstructured":"Health Canada.\n                      Summary Basis of Decision (SBD) for XIAFLEX 2012. http:\/\/www.hc-sc.gc.ca\/dhp-mps\/prodpharma\/sbd-smd\/drug-med\/sbd_smd_2012_xiaflex_147788-eng.php (date last accessed 31 May 2013)."},{"key":"r5","unstructured":"Canadian Institute for Health Information.\n                      Aggregate Data on Dupuytren\u2019s Contracture Treatment in Canada for the 2009-2010 Fiscal Year. 2012."},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2010.01.003"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1016\/J.JHSB.2006.03.174"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31823aea95"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.02.021"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0810866"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1177\/1753193410376286"},{"key":"r12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2007.04.002"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2010.08.007"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2011.08.004"},{"key":"r15","unstructured":"Pollack A.\n                      Bringing movement back to clenched hands.\n                      New York Times\n                      2010 March 10, 2010. http:\/\/www.nytimes.com\/2010\/03\/16\/business\/16handbar.html?_r=0 (date last accessed 8 May 2013)."},{"key":"r16","unstructured":"No authors listed.\n                      Guidelines for the economic evaluation of health technologies: Canada\n                      . 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Ottawa: Canadian Agency for Drugs and Technologies in Health, 2006."},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540150055031"},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9701700202"},{"key":"r19","doi-asserted-by":"publisher","DOI":"10.1053\/jhsu.2002.35299"},{"key":"r20","first-page":"808","volume":"601","author":"Badois FJ","year":"1993","journal-title":"Rev Rhum Ed Fr"},{"key":"r21","doi-asserted-by":"publisher","DOI":"10.1016\/J.JHSB.2005.07.001"},{"key":"r22","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B3.21054"},{"key":"r23","unstructured":"Statistics Canada.\n                      Health at a glance, April 2011.http:\/\/www.statcan.gc.ca\/daily-quotidien\/110415\/be110415a-eng.htm (date last accessed 8 May 2013)."},{"key":"r24","unstructured":"Auxilium Pharmaceuticals, Inc.\n                      Using Xiaflex. 2011. https:\/\/www.xiaflex.com\/hcp\/using_XIAFLEX.jsp (date last accessed 8 May 2013)."},{"key":"r25","unstructured":"Ministry of Health and Long Term Care \u2013 Ontario.\n                      OHIP Schedule of Fees: Physician Services under the Health Insurance Act (September 1, 2011)."},{"key":"r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2005.05.008"},{"key":"r27","doi-asserted-by":"publisher","DOI":"10.1097\/01.bth.0000186794.90431.a4"},{"key":"r28","doi-asserted-by":"publisher","DOI":"10.1177\/1753193411407245"},{"key":"r29","unstructured":"Statistics Canada.\n                      CANSIM Table 202-0407: income of individuals, by sex, age group and income source, 2009 constant dollars. http:\/\/www5.statcan.gc.ca\/cansim\/a26?lang=eng&\nretrLang=eng&\nid=2020407&\npaSer=&\npattern=&\nstByVal=1&\np1=1&\np2=-1&\ntabMode=dataTable&\ncsid=#F1 (date last accessed 8 May 2013)."},{"key":"r30","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.14.1637"},{"key":"r31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2012.04.026"},{"key":"r32","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X9701700203"},{"key":"r33","first-page":"15","volume":"4","author":"Lermusiaux JL","year":"2009","journal-title":"European Dermatology"}],"container-title":["The Bone &amp; Joint Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.95B8.31822","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.95B8.31822","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.95B8.31822","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T19:16:12Z","timestamp":1634584572000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.95B8.31822"}},"subtitle":["A Canadian cost-utility analysis of current and future management strategies"],"short-title":[],"issued":{"date-parts":[[2013,8]]},"references-count":33,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2013,8]]}},"alternative-id":["10.1302\/0301-620X.95B8.31822"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.95b8.31822","relation":{},"ISSN":["2049-4394","2049-4408"],"issn-type":[{"value":"2049-4394","type":"print"},{"value":"2049-4408","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8]]},"assertion":[{"value":"2013-02-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-04-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2013-08-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}