Researchers comparing cost and outcomes for surgery, collagenase clostridium histolyticum (CCH [Xiaflex]), and RestoreX traction therapy for Peyronie’s disease found traction is the most cost-effective option for achieving 20% or greater curvature improvement, but CCH or surgery might be more cost-effective and efficacious in specific scenarios.
Authors of the study, published in the Journal of Sexual Medicine (2019; 16:1421-32), compared 201 Peyronie’s disease patients who were treated with the RestoreX traction device, CCH, or the surgical options plication or incision and grafting at Mayo Clinic, Rochester, MN.
They found the overall success rate of surgery was 96%, compared with 66% with CCH and 48% with traction. At a decade post treatment, traction was the most cost-effective with an average per-patient cost of $883, compared to $11,419 for surgery and $33,628 for CCH.
But those percentages and costs don’t tell the whole story. CCH, the most expensive option, resulted in the highest quality of life years rating due to relatively low complications and intermediate rates of success, researchers said. And the high rate of success with surgery was tempered by intermediate costs and high morbidity.
Research models have to take several factors into consideration when comparing procedures like these, according to study author and urologist Landon Trost, MD, of the Male Fertility and Peyronie’s Clinic in Orem, UT. One example: Gold-standard surgical options of plication and incision and grafting are associated with complications such as erectile dysfunction.
“You have to take these side effects into account in any cost-effective model. If you take someone who is not dependent on erectile dysfunction meds, for example, and you make them dependent on meds and maybe even surgery with an implant, that adds to potential costs,” Dr. Trost said.
A debate among members of the International Society for Sexual Medicine is whether high cost is a potential knockout factor for CCH and urologists should instead perform surgery for Peyronie’s disease, according to Dr. Trost.
“But I think one of the key take-homes from the study is that Xiaflex is indeed a cost-effective therapy and it’s worthwhile for people to consider undergoing that treatment,” he said. “Traction of course is the most cost-effective because it’s such an inexpensive therapy, but it also has the least overall effectiveness compared to injections or surgery. Surgery is by far the most effective but has the most side effects.”