A penile traction therapy called RestoreX might be the most cost-effective treatment option for men with Peyronie’s disease, but goals and preferences still play an important role in patient choice, experts say in a recent Journal of Sexual Medicine study.
When a man has Peyronie’s disease, areas of hardened scar tissue called plaques form on his penis. The plaques make the penis less flexible, and as a result, the penis bends. In some cases, the curvature is enough to make intercourse difficult.
There are several ways to treat Peyronie’s disease, but three common ones are:
- Surgery to correct the curvature and straighten the penis.
- Injections of collagenase Clostridium histolyticum (CCH) directly into the plaques.
- Traction therapy – stretching the penis with a device like the RestoreX, which is used 30-90 minutes every day.
Researchers looked at data from 201 men who had been treated for Peyronie’s disease. One hundred fifteen men had CCH injections, 23 underwent surgery, and 63 used the RestoreX traction device.
For this study, success was defined as a curvature improvement of at least 20 degrees, an accepted benchmark based on past research. The men’s progress was followed for 10 years after treatment. Costs were calculated based on payer costs, such as Medicare reimbursements.
Overall, 96% of the men in the surgery group, 66% of the CCH group, and 48% of the RestoreX group met the success benchmark.
After considering 10 years of follow-up, the RestoreX was considered the most cost-effective treatment option, with an average per-patient cost of $883. Surgery came in second at an average of $11,419 per patient, and CCH was the most expensive with an average per-patient cost of $33,628.
However, each per-patient cost was not necessarily what each patient paid individually for his treatment. The figures did not take insurance or manufacturers’ rebates into account. In fact, surgery cost more than CCH when patient out-of-pocket costs were determined.
Cost-effectiveness could also depend on complication rates (such as during and after surgery), patients’ goals, and patients’ treatment preferences. For some men with Peyronie’s, decreasing curvature isn’t always the first priority. Penile shortening, deformity, erectile dysfunction, pain, and other concerns may be more important. So while one treatment could be more cost-effective than another, it might not meet the patient’s goals. In addition, men may prefer one type of treatment over another, such as RestoreX over surgery.
“Ultimately, the preferred treatment option for patients is only partially driven by cost-effectiveness analyses and is dependent on patient preference and goals of therapy, provider experience, insurance coverage, and clinical considerations,” the authors concluded.
Resources
The Journal of Sexual Medicine
Wymer, Kevin, MD, et al.
“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”
(Full-text article in press. Published online: July 24, 2019)
https://www.jsm.jsexmed.org/article/S1743-6095(19)31269-X/fulltext
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