Collagenase clostridium histolyticum is a recognised non-surgical management for Peyronie's disease, licensed for use in the UK for patients with a palpable plaque and a curvature deformity of at least 30°. However, it is not currently funded for use within the National Health Service [NHS]. Collagenase clostridium histolyticum has also recently been withdrawn from the European and other markets worldwide, but there is potential for this to be produced off-patent in the future.
To determine if collagenase clostridium histolyticum is cost-neutral when compared to surgical management within a public health care system, using the NHS as an example.
Two published protocols for the administration of collagenase in Peyronie's disease were identified - the 'IMPRESS protocol' and the 'London protocol'. Costs were taken from published NHS literature. Surgical interventions rates after collagenase clostridium histolyticum administration and primary penile plication were taken from published literature. The costs of the two published protocols were calculated with costs of any repeat surgical intervention were included within each protocol per patient cost.
At the current cost per vial of collagenase to the NHS, the IMPRESS protocol per patient costs £3898.83 (150%) more than primary surgery, while the London protocol costs £136.83 (5.3%) more than primary surgery.
At a cost of £526.39 per vial, collagenase administered under the London Protocol would be a management option for Peyronie's disease cost equivalent to primary corrective surgery.
Central funding of collagenase in a public healthcare system would enable the management of Peyronie's disease to be moved to the outpatient setting. For this to be done at no additional cost to the NHS it would require a cost reduction per vial of collagenase of £45.61, to a cost of £526.39.
Andrology. 2020 May 27 [Epub ahead of print]
Neil Harvey, Ian Pearce
Urology Department, Stepping Hill Hospital, Stockport NHS Foundation Trust, Poplar Grove, Stockport, SK2 7JE, United Kingdom., Urology Department, Manchester Royal Infirmary, Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, M13 9WL, United Kingdom.