Is there a line between ethics and market competition? Lights and shades of the withdrawal of collagenase treatment for Peyronie's disease.

Peyronie's disease treatments is changing again due the interruption of Xiapex® distrubution in Europe. There are many reasons that can be referred to this event. In this editorial we would like to shed light on the current cost items relating to treatment with collagenase clostridium histolyticum (CCH). The inaccessibility of the drug has seen both an increase in surgery for the treatments of both PD and Dupuytren's disease and an interruption of therapies in patients who had not completed their therapeutic cycle. Considering the aforementioned concerns, we would like to invite researchers dealing with PD to conduct studies with the available CCH products in collaboration with the drug companies in order to give again an efficacious treatment for PD.

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.

BACKGROUND: Traditionally, surgery has been considered the gold standard treatment for Peyronie's disease (PD). Less-invasive alternatives, such as collagenase Clostridium histolyticum (CCH) and traction therapy, have been proposed and proven effective. AIM: To compare cost-effectiveness of management options for PD. METHODS: A Markov analytic model was created to compare the cost-effectiveness of treatment with a novel traction device, RestoreX (RXPTT), vs CCH vs surgery. Outcomes were derived from single-institution, prospective data of 63 men treated with RXPTT, 115 with CCH, and 23 with plication or incision and grafting. Costs were based on 2017 Medicare reimbursement and utility values from the literature. MAIN OUTCOME MEASURES: Model outcomes included complications for each treatment arm, as well as the probability of success, which was defined as ≥20% improvement in curvature. Univariable and multivariable sensitivity analyses were performed to test the robustness of the model. RESULTS: Overall success rates were 96% (surgery), 66% (CCH), and 48% (RXPTT). At 10 years after treatment, RXPTT was the most cost-effective, with mean costs per patient of $883 (RXPTT), $11,419 (surgery), and $33,628 (CCH). CCH and surgery both resulted in a gain of quality adjusted life years (QALYs) relative to RXPTT (9.44 and 9.36 vs 9.27, respectively). Sensitivity analysis demonstrated greater cost-effectiveness for surgery if lower (≤46%) rates of postoperative erectile dysfunction or length loss (≤3%). CCH became more cost-effective at lower costs (≤$16,726) or higher success rates (≥76%). On multivariable sensitivity analysis at a willingness to pay threshold of $100,000/QALY, the most cost-effective strategy was RXPTT in 49%, surgery in 48%, and CCH in 3% of simulations. At a willingness to treat threshold of $150,000/QALY, the most cost-effective treatment option was RXPTT in 33%, surgery in 55%, and CCH in 12% of simulations. CLINICAL IMPLICATIONS: In an era of value-based care, this model can guide cost-effective treatment selection on the basis of provider, patient, and payer characteristics. STRENGTHS & LIMITATIONS: The current study represents the first cost-effectiveness comparison of treatment modalities for PD and is strengthened by prospective data collection, large CCH and traction sample sizes, and robust sensitivity analyses. Consistent with cost-effective models, the model is limited by assumptions and may not apply to all scenarios. CONCLUSIONS: RXPTT represents a more cost-effective method for achieving ≥20% curvature improvement compared with surgery or CCH. Depending on treatment goals, rate of surgical complications, and willingness to pay threshold, surgery and CCH may become more cost-effective in select scenarios. Wymer K, Kohler T, Trost L. 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. J Sex Med 2019;16:1421-1432.

Análisis clínico y coste económico-sanitario de nuestra serie de 65 casos de incurvación de pene / Clinical analysis and economic-health cost of 65 cases of penile incurvation

Introducción. El objetivo del estudio es analizar las características epidemiológicas y clínicas, el gasto sanitario global medio y las variables que se han relacionado de forma estadísticamente significada con la aparición de la incurvación de pene. Material y métodos. el estudio analiza retrospectivamente 65pacientes intervenidos de incurvación peneana entre enero del 2000 y octubre del 2011. Para comprobar qué variables se relacionaban con la incurvación del pene, se utilizó el test chi-cuadrado de Pearson con corrección por continuidad, y Fisher en los casos que no se cumplieron las condiciones de aplicabilidad. Para las variables cuantitativas se utilizó el test t de Student. Resultados. La mediana de edad fue de 53años. La incurvación peneana diagnosticada con mayor frecuencia fue la dorsal (49,25%). El 80% de las incurvaciones fueron adquiridas. En la exploración se palpó placa indurada en el 50,8% de los pacientes con incurvación adquirida. La técnica quirúrgica empleada en el 81,5% de los casos fue la plicatura de la albugínea de Essed-Schröder. La estancia hospitalaria media fue de 24h. Se observó una relación estadísticamente significativas entre hipertensión (p=0.013), diabetes (p=0,033) y palpación de placa (p=0,009) e incurvación dorsal. En el 60% de los pacientes con incurvación ventral esta fue de causa congénita, encontrando una asociación estadísticamente significativa entre ambas (p=0,003). El coste sanitario global medio de un paciente intervenido de incurvación de pene fue de 2.142euros. Conclusiones. La incurvación de pene se está convirtiendo en una patología emergente en las consultas de urología, y presenta resultados quirúrgicos satisfactorios (AU)

Introduction. The aim of this study is to analyze the epidemiological and clinical characteristics, average overall health cost, and variables that have a statistically significant relationship with the appearance of penile incurvation. Materials and methods. This retrospective study analyzes 65 patients who received treatment for penile incurvation between January 2000 and October 2011. Pearson's chi-square test with correction for continuity was used to verify which variables are related to penile incurvation. Fisher's exact test was used in cases where applicability conditions were not met. The Student's t test was used for the quantitative variables. Results. Median age was 53years. Dorsal type (49.25%) was the most frequently diagnosed penile incurvation with 80% of the incurvations being acquired. Upon exploration, an indurated plaque was palpable in 50.8% of the patients with acquired incurvation. Schroeder-Essed plication of the tunica albuginea was the surgical technique used in 81.5% of the cases. Mean hospital stay was 24hours. A statistically significant relationship was observed between dorsal incurvation and hypertension (P=.013), diabetes (P=.033), and plaque palpation (P=.009). In 60% of the patients with ventral incurvation, it resulted from congenital causes, a statistically significant association being found between both (P=.003). Overall average health cost of a patient treated for penile incurvation was 2,142euros. Conclusions. Penile incurvation is an emerging condition in urology consultations with some satisfactory surgical results (AU)