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Journal of Hand Surgery Global Online logoLink to Journal of Hand Surgery Global Online
. 2026 May 25;8(4):101042. doi: 10.1016/j.jhsg.2026.101042

Trends in Treatment and Reimbursement of Dupuytren Disease

Luna Toma ∗,†, Ethan Cossu ∗,†, Leah Demetri ∗,†, Dafang Zhang ∗,†, Philip E Blazar ∗,†, Brandon E Earp ∗,†,∗
PMCID: PMC13227201  PMID: 42239926

Abstract

Purpose

Dupuytren disease (DD) is a fibroproliferative disorder that can result in progressive hand contractures and functional impairment. Multiple treatment options are available, ranging from minimally invasive procedures to surgical interventions. Current long-term trends in treatment utilization and reimbursement remain incompletely characterized. Understanding these trends is essential for clinical decision-making and resource allocation.

Methods

A retrospective longitudinal analysis was conducted using Medicare data from 2005 to 2024. Treatment utilization and reimbursement data were extracted for current procedural terminology codes corresponding to percutaneous needle fasciotomy (PNF), open fasciotomy, collagenase Clostridium histolyticum injection (CCH) with manipulation, and fasciectomy-based procedures. Annual procedure volumes were normalized to Medicare enrollment. Reimbursement values were adjusted for inflation using the US Consumer Price Index. Temporal trends were assessed using the 2-tailed Mann–Kendall trend test.

Results

Utilization of surgical procedures declined significantly over the study period, whereas PNF and CCH demonstrated no individual temporal trends. When grouped as minimally invasive procedures, PNF and CCH showed an overall increase in utilization. A transient decline in utilization across all procedures occurred in 2020, followed by partial recovery in subsequent years. Normalized annual procedure volumes for DD demonstrated no significant temporal trend. Inflation-adjusted Medicare reimbursement per service declined significantly by 38% over the study period; fasciectomy-based procedures remained the highest reimbursed interventions and showed no significant temporal change. In contrast, reimbursement for PNF and CCH declined significantly over time.

Conclusions

Over the past 2 decades, minimally invasive treatment of DD has become more common, whereas fasciectomy has been declining. Nevertheless, fasciectomy remains the most commonly performed treatment for DD. Decreasing inflation-adjusted reimbursement highlights growing economic pressures on health care and providers.

Type of study/level of evidence

Economic decision and analysis IV

Key words: Collagenase Clostridium histolyticum, Fasciectomy, Inflation-adjusted reimbursement, Medicare, Percutaneous needle fasciotomy

Dupuytren disease (DD) is a chronic fibroproliferative disorder of the palmar fascia that can lead to contractures and associated functional impairment of the hand. Several treatment options are available for DD and are selected based on patient preference, surgeon experience, and cost.1 Treatments range from minimally invasive, office-based procedures to surgical interventions. Percutaneous needle fasciotomy (PNF) achieves cord division using a needle, and Collagenase Clostridium histolyticum (CCH) injection enzymatically degrades the collagen within cords, allowing cord rupture through manual manipulation.1,2 Open surgeries including open fasciotomy (OF) and limited fasciectomy (LF) are additional options.

Evaluating how management choices for Dupuytren contracture evolve over time is important for shaping healthcare policy, planning resource use, and enhancing patient care. Variation in treatment may reflect changes in evidence, clinical practice, patient expectations, marketing efforts (eg, pharmaceutical industry promotion), or economic influences within the healthcare system (eg, financial pressures on physicians to favor certain treatment modalities). We aim to (1) describe the utilization of various treatment options for DD over 20 years using US Medicare claims data and (2) describe the inflation-adjusted reimbursement rates of these procedures during the study period.

Materials and Methods

Medicare is a US health insurance program that provides medical coverage for individuals aged ≥65 years and for younger individuals with qualifying health conditions. Treatment utilization and reimbursement data for DD were extracted from the publicly available Medicare Part B National Summary Data Files for the following current procedural terminology (CPT) codes:3 26,040 (percutaneous needle aponeurotomy, PNF), 26,045 (open partial palmar fasciotomy, OF), 20,527 (CCH injection), 26,341 (manipulation following collagenase injection), 26,121 (palm-only fasciectomy), 26,123 (partial palmar fasciectomy with release of a single digit), and 26,125 (additional digit fasciectomy). For each CPT code, annual service volumes and Medicare payments were extracted for the period from 2005 to 2024. CPT codes 20,527 and 26,341 were included from 2012 to 2024, as no data were available prior to that year. CCH was approved for the treatment of DD by the US FDA in 2010, and prior to 2012, CCH was treated under an unlisted CPT code.

Temporal trends from 2005 to 2024 were assessed for overall services and payments as well as for each individual CPT code using the 2-tailed Mann–Kendall trend test. Kendall’s τ coefficient and its associated P values were calculated. Statistical significance was defined as P < .05, and temporal trends were classified as increasing, decreasing, or absent at the 95% confidence level.

To ensure consistency in the evaluation of financial trends over the entire period, monetary values were adjusted for inflation using the United States All Items Consumer Price Index provided by the US Bureau of Labor Statistics, with 2024 serving as the baseline year.4 To account for potential increases in procedure frequencies attributable solely to growth in the Medicare population, procedural utilization was normalized to annual Medicare enrollment data obtained from publicly available Medicare Enrollment Reports and the Centers for Medicare & Medicaid Service Statistics Reference Booklets.5,6 Specifically, annual procedure volumes were divided by the corresponding number of Medicare beneficiaries for each year and multiplied by 100,000, yielding utilization rates per 100,000 beneficiaries.

This study was exempt from institutional review board approval because it used only publicly available deidentified data.

Results

Treatment trends

Over the 20-year study period from 2005 to 2024, a total of 764,742 services for DD were billed to Medicare using the investigated CPT codes. From 2005 to 2024, Dupuytren procedure volumes rose by 83% from approximately 26,400 procedures in 2005 to 48,200 in 2024. Prior to normalization, there was a significant increasing trend in overall DD treatment utilization over the study period (Kendall’s τ = 0.8, P < .001). However, following normalization for Medicare enrollment, no significant temporal trend was observed (Kendall’s τ = 0.2, P = .38). Accordingly, Medicare enrollment from 2005 to 2024 demonstrated a significant increasing trend (τ = 1.0, P < .001), rising by approximately 62% over the study period. Across all procedures, a decline in utilization was observed in 2020, followed by partial recovery in subsequent years (Fig. 1).

Figure 1.

Figure 1

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Normalized utilization trends of Dupuytren disease treatments per 100,000 Medicare beneficiaries from 2005 to 2024. Trends are shown for percutaneous needle fasciotomy (PNF), Collagenase Clostridium histolyticum (CCH) injection, palm-only fasciectomy, partial palmar fasciectomy with digital release, and open fasciotomy. CPT codes for collagenase injection and subsequent manipulation are included from 2012 to 2024, as no data were available prior to that year. Arrows in the legend denote increasing (↑), decreasing (↓), or no (↔) temporal trends. CPT, current procedural terminology.

Normalized utilization of CCH injections and manipulation did not demonstrate significant temporal trends (τ = −0.1, P = .8, and τ = −0.3, P = .2). However, the utilization of collagenase injections increased intermittently from approximately 13 procedures per 100,000 beneficiaries in 2012 (the first year with available data), peaked at 16 procedures per 100,000 beneficiaries in 2019, and declined to 13 procedures per 100,000 beneficiaries in 2024 (Fig. 1). PNF also showed no significant trend after normalization (τ = 0.3, P = .1). However, its utilization reached its highest levels between 2010 and 2012, followed by a notable short-term decline until 2015 before stabilizing and increasing again in later years (Fig. 1).

Accounting for changes in enrollment, utilization of surgical interventions showed significant decreasing trends, including palm-only fasciectomy (τ = −0.7, P < .001), partial palmar fasciectomy with digital release (τ = −0.5, P < .01), OF (τ = −0.8, P < .001), and additional digital fasciectomy (τ = −0.7, P < .001). Partial palmar fasciectomy with digital release remained the most frequently performed treatment (Fig. 1) at 34% of all normalized services in 2024, followed by collagenase injection at 18%.

When clustering PNF and CCH into a single category of minimally invasive services, and grouping palm-only fasciectomy, partial palmar fasciectomy with digital release, and OF as surgical procedures, opposing temporal trends emerge (Fig. 2). Adjusted minimally invasive services show a significant increasing trend (τ = 0.6, P < .001), whereas adjusted surgical procedures demonstrate a significant decreasing trend (τ = −0.5, P = .01). Notably, both modalities exhibited the most pronounced changes up to 2012 (Fig. 2).

Figure 2.

Figure 2

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Normalized utilization trends of clustered Dupuytren disease treatments per 100,000 Medicare beneficiaries, 2005-2024. Minimally invasive procedures include PNF and CCH, whereas surgical procedures include palm-only fasciectomy, partial palmar fasciectomy with digital release, and open fasciotomy. Collagenase CPT codes were available from 2012 to 2024. Arrows in the legend denote increasing (↑) or decreasing (↓) temporal trends. CCH, collagenase Clostridium histolyticum; CPT, current procedural terminology; PNF, percutaneous needle fasciotomy.

Reimbursement trends

Total inflation-adjusted Medicare payments demonstrated a significant increasing trend (τ = 0.65, P < .001) from around US $17.6 million in 2005 to US $20.2 million in 2024. Analysis of inflation-adjusted Medicare reimbursement per service, however, revealed a significant overall decline in average payment of 38 % (τ = −0.8, P < .001). Average-adjusted reimbursement declined from US $680 in 2005 to US $420 in 2024.

Across individual procedures, reimbursement trends were characterized by either significant decreases or an absence of temporal change. Average reimbursement for CCH injection and manipulation following the injection demonstrated a significant decrease of 27% from $78 in 2012 to $57 in 2024 (τ = −0.7, P < .001, and τ = −0.7, P < .01). It is important to note that these figures reflect procedure reimbursement only and do not include the cost of the collagenase drug itself, which represents a substantial additional expense. PNF also exhibited a statistically significant decline of 30% in reimbursement (τ = −0.4, P < 0.05; Fig. 3), showing the largest decline from $411 in 2005 to $287 in 2024. No statistically significant temporal trend in reimbursement was observed for OF ($512 in 2005, $483 in 2006, and $497 in 2024; τ = 0.1, P = .9).

Figure 3.

Figure 3

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Inflation-adjusted Medicare reimbursement per service for Dupuytren disease treatments from 2005 to 2024, expressed in 2024 US dollars. Trends are shown for the reimbursement of percutaneous needle fasciotomy (PNF), Collagenase Clostridium histolyticum (CCH) injection excluding drug costs, palm-only fasciectomy, partial palmar fasciectomy with digital release, and open fasciotomy. Arrows in the legend denote increasing (↑), decreasing (↓), or no (↔) temporal trends.

Inflation-adjusted reimbursement for palm-only fasciectomy showed no significant temporal trend (τ = 0.20, P = .40), with reimbursement of $667 in 2005, $751 in 2015, and $651 in 2024. Partial palmar fasciectomy with digital release likewise demonstrated no significant temporal trend (τ = 0.10, P = .70) and consistently represented the highest reimbursed procedure throughout the study period (Fig. 3), with reimbursement of $877 in 2005, $997 in 2016, and $829 in 2024. Open fasciotomy showed no significant temporal trend in inflation-adjusted reimbursement (τ = 0.10, P = .97), with reimbursement of $512 in 2005, $583 in 2015, and $497 in 2024. In contrast, reimbursement for additional digital fasciectomy declined significantly over the study period (τ = −0.90, P < .001). Across all procedures, the lowest reimbursements were observed for the minimally invasive collagenase injection (excluding drug cost) and PNF (Fig. 3).

Discussion

Several studies have analyzed treatment or reimbursement trends in DD.7, 8, 9 The present study was designed to examine long-term trends in treatment and reimbursement over 2 decades, including disruptions associated with changes related to the introduction and international withdrawal of CCH. In this longitudinal analysis of Medicare data, we observed substantial shifts in both treatment utilization patterns and reimbursement for DD.

There exists a variety of treatment options for DD, and the optimal choice is unclear. PNF yields satisfactory outcomes with lower complication rates, shorter recovery times, and reduced costs compared with surgical interventions but higher rates of recurrence.10, 11, 12 Multiple studies recommend PNF as a cost-effective primary treatment for Dupuytren contractures with similar deformity correction and recurrence rates compared with CCH.13, 14, 15, 16 Jain et al.9 conducted a national cost and utilization analysis comparing CCH, PNF, and fasciectomy for the treatment of DD using a large US database from 2015 to 2019. Their study demonstrated an increasing utilization of minimally invasive modalities, alongside a corresponding decline in fasciectomy. Notably, Jain et al.10 observed that PNF was the least frequently performed procedure, despite being the least costly. Similarly, we found that PNF utilization remained lower than that of fasciectomy and CCH through 2024 with no increasing trend, suggesting a disconnect between published research outcomes and their adoption in clinical practice. This disconnect is likely multifactorial in origin, reflecting differences in surgeon training and procedural familiarity, as well as the influence of industry marketing on treatment preferences.

CCH was approved by the US Food and Drug Administration in 2010 and was withdrawn from international markets approximately a decade later because of medication cost constraints, although it continues to be used in the United States. Despite low complication rates and short recovery times, there is a higher recurrence rate than with LF.13,17 Although no statistically significant trend was detected, a general decline was observed during the final 4 years of the study period, coinciding with the international withdrawal of this treatment modality. Pistone et al.7, in an analysis of Medicare data from 2012 to 2022, reported growth in normalized CCH utilization; however, this trend did not continue in our analysis through 2024.

The absence of an ongoing trend in CCH utilization likely reflects the relatively recent introduction of collagenase therapy, characterized by an initial phase of adoption followed by fluctuating utilization as clinical evidence accumulated and practice patterns evolved. We observed that PNF utilization declined from 2010 to 2015, coinciding with the introduction of CCH, before stabilizing and increasing again in later years. This pattern suggests that CCH initially might have partially displaced PNF as an alternative minimally invasive treatment, with subsequent readoption of PNF as evidence accumulated supporting its greater cost-effectiveness. This explanation would also fit with our data, which failed to identify an ongoing trend in the utilization of PNF.

The patterns found in this study suggest a shift away from more invasive surgical approaches toward minimally invasive techniques, likely reflecting evolving preferences for procedures with shorter recovery times, lower complication rates, and reduced resource utilization. However, this interpretation should be made with caution, as treatment choice for DD is made in part by disease severity, contracture location, and patient and surgeon factors. Several other explanations may fit with this observation. First, it may reflect patient and/or surgeon changes in preference and/or comfort with the minimally invasive procedures. Second, as the evidence on these procedures has evolved over this time period, practice patterns have responded to the documented success of these procedures. Fasciectomy-based procedures remain the most commonly performed treatment modalities in the Medicare population, consistent with the observations of Jain et al.9 in their analysis from 2015 to 2018. This pattern may reflect a higher severity of contractures within the Medicare population. Alternatively, this may indicate that treatment selection is influenced by the more favorable reimbursement for surgical procedures. Comparisons with non-Medicare populations, nationwide data, or international cohorts may provide further insight into evolving management of DD, as its prevalence is influenced by multiple factors, including age and genetics and therefore varies substantially across geographic regions and likely with insurance type.18

Richman et al.8 also reported a substantial increase in normalized DD treatment volumes from 2000 to 2021, but this was driven largely by widespread adoption of CCH while PNF declined. In contrast to their findings, our analysis over a more recent 20-year time period from 2005 to 2024 demonstrated stable overall utilization, with declining use of surgical procedures and no trend for CCH and PNF. Although Richman et al.8 observed a decline in PNF utilization following the introduction of CCH, our findings suggest subsequent growth in the use of PNF or alternatively a cyclical pattern. Both studies, however, demonstrate declining inflation-adjusted reimbursement for DD treatments, with the greatest reductions affecting PNF, underscoring persistent financial pressures despite evolving treatment preferences.

Across all analyzed procedures, a decline in utilization was observed in 2020. This observation is consistent with the widespread disruption of elective procedures during the COVID-19 pandemic. Importantly, the recovery of utilization in subsequent years indicates that these declines were short-term and do not reflect sustained changes in treatment trends. Still, total Dupuytren service volumes have not returned to pre-COVID-19 levels. The presence of this exogenous shock likely contributed to increased variability in year-to-year utilization and may have attenuated the detection of trends for certain procedures, particularly those with shorter observation periods like CCH.

Declining reimbursement has posed challenges for physicians across different surgical specialties.19,20 Within hand surgery specifically, average inflation-adjusted reimbursement for the 20 most common procedures has decreased by 21% from 2000 to 2019.21 In comparison, our analysis demonstrates a more pronounced overall reduction, with a 38% decline in average inflation-adjusted reimbursement across overall DD procedures. However, this decline was not seen for the most common fasciectomy procedures.

The findings of this study should be interpreted in the light of its limitations. First, this study only used Medicare data. Therefore, the trends observed in this study may not represent those in other populations or with other payors; however, Medicare data often mirror broader health care trends.22 Second, the reimbursement data do not include additional services, such as clinic visits or costs related to complications. Third, the data’s accuracy depends on accurate hospital and clinician coding. Fourth, this study is limited by the inability of the Medicare dataset to distinguish between primary and recurrent DD treatments or to identify the number of individual patients receiving services, as the data are reported at the service level rather than the patient level. Finally, analyses in younger populations may reveal different trends, as the disease can present more aggressively at earlier ages.23

Our study identified increased utilization of minimally invasive procedures, yet decreased reimbursement for these procedures. The use of less invasive procedures overall increased steadily over this time period with variation in the 2 components; PNF use declined and then recently rebounded, whereas the use of CCH increased and then waned. Surgical management remained the most common treatment. DD represents a substantial burden on Medicare and the US healthcare system, and differences in healthcare resources and management strategies may contribute to variation in clinical approaches.24,25

Conflicts of Interest

No benefits in any form have been received or will be received related directly to this article.

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