This study is an interesting case study with regard to pharmaceutical marketing. Although DC is a relatively small disease, Auxilium pharmaceuticals spent $18.2 million in advertising in 2010, placing them at #23 in the top 25 largest pharma advertisement spending of that year (Bulik 2011). The health profession and public were inundated with front-page advertisements in magazines, orthopedic journals, and major exhibits at many national medical conferences.

Not surprisingly, the introduction of CCH into the marketplace in 2010 leads to an increasing trend in the diagnosis of Dupuytren contracture over the next three years. This is likely more a phenomenon of increased awareness of the disease than a true spike in the incidence of DC in the population. We hypothesize that the increased awareness of the disorder and hope for a nonsurgical option led patients to seek medical attention that otherwise would not have.

In the year 2013 in the United States, 42 % of treatment for DC was not open surgery, compared with only 15 % in 2007. In over two centuries, the progress of DC treatment was limited to surgical improvements. CCH provided an alternative treatment that was readily accepted and adopted.

The increased CCH use correlates with the decrease in surgery. It makes sense that there would be a decline in the percentage of open surgical procedures with a novel nonsurgical option. Meanwhile, the number of NA procedures remained steady throughout the study period. The consistency within NA treatment suggests that those practitioners who perform NA were not swayed to CCH, but further research into this is needed.

The number of open surgery cases follows a predictable seasonal variation with more procedures during the winter months while closed NA and CCH injections were consistent throughout the year. This is a unique finding within the Dupuytren surgery population. In a review of the literature, there are no other reported elective hand surgical cases with this seasonal variation. There is not an overall increase in other surgeries during the winter months, and this must represent a preference for DC patients. We surmise that the patients are less likely to undergo surgery during the warm weather months when casts and bandages are less accepted and patients want to use their hands for work and leisure activities.

These preliminary results are a descriptive analysis of US Dupuytren contracture data. Further statistical analyses in the finished study will greatly expand and strengthen the validity of these current observations.