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UPJ INSIGHT Geographic Variation in Access to Collagenase Clostridium histolyticum Injectors for Peyronie’s Disease

By: Michael Sischka, BS, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; Alexander Krueger, BS, Mayo Clinic Alix School of Medicine, Rochester, Minnesota; Niki Parikh, MD, Mayo Clinic, Rochester, Minnesota; Tobias Köhler, MD, Mayo Clinic, Rochester, Minnesota; Sevann Helo, MD, Mayo Clinic, Rochester, Minnesota; Matthew Ziegelmann, MD, Mayo Clinic, Rochester, Minnesota | Posted on: 15 Dec 2023

Sischka M, Krueger A, Parikh N, Köhler T, Helo S, Ziegelmann M. Significant geographic variation in access to certified collagenase Clostridium histolyticum injectors for Peyronie’s disease throughout the United States. Urol Pract. 2023;10(6):680-687.

Study Need and Importance

Intralesional collagenase Clostridium histolyticum (CCH) is an approved nonsurgical treatment for Peyronie’s disease that results in significant improvements in penile curvature and symptom-associated bother. There is a projected workforce shortage within urology, and geographic proximity is an important barrier to health care. We sought to evaluate the geographic distribution of clinical sites offering CCH throughout the United States.

What We Found

We identified significant geographic variation in the distribution of approved CCH clinical sites (n = 23,888; Figure). The average number of sites offering CCH per state was 47. When we broke this down by state population, there were notable differences. States with the highest ratio of CCH sites per 100,000 residents included Georgia (1.28), Rhode Island (1.13), and Alaska (1.10), whereas New Mexico (0.10), Maine (0.22), and Delaware (0.30) had the lowest ratios. We also looked at availability relative to the number of urologists. States with the highest ratio of CCH sites to total urologists included Georgia (0.37), Alaska (0.31), and Utah (0.30), whereas New Mexico (0.03), Maine 133 (0.05), and Vermont (0.06) had the lowest ratio.

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Figure. Geographic distribution of clinical sites offering collagenase Clostridium histolyticum.

Limitations

Our assessment relied on data obtained from a publicly available search tool. The frequency at which this information is updated is unknown. State population and urology workforce data were derived from the US Census and the AUA Census, which may not account for the entire population or number of urologists in a given state. Finally, our analysis relied on state- rather than county-level data, which could provide greater insight into rural vs urban access.

Interpretation for Patient Care

There are notable geographic differences in access to CCH for patients with Peyronie’s disease. Given that CCH is a time-intensive treatment course with associated opportunity costs, efforts should be made to increase the number of trained CCH injectors, particularly in underserved areas.

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