Original Research Article

PharmacoEconomics

, Volume 22, Issue 3, pp 185-195

First online:

Cost Effectiveness of Interventions for Lateral Epicondylitis

Results from a Randomised Controlled Trial in Primary Care
  • Ingeborg B. C. Korthals-de BosAffiliated withInstitute for Research in Extramural Medicine, VU University Medical Center Email author 
  • , Nynke SmidtAffiliated withInstitute for Research in Extramural Medicine, VU University Medical Center
  • , Maurits W. van TulderAffiliated withInstitute for Research in Extramural Medicine, VU University Medical CenterDepartment of Clinical Epidemiology and Biostatistics, VU University Medical Center
  • , Maureen P. M. H. Rutten-van MölkenAffiliated withInstitute for Medical Technology Assessment, Erasmus University
  • , Herman J. AdèrAffiliated withDepartment of Clinical Epidemiology and Biostatistics, VU University Medical Center
  • , Daniëlle A. W. M. van der WindtAffiliated withInstitute for Research in Extramural Medicine, VU University Medical CenterDepartment of General Practice, VU University Medical Center
  • , Willem J. J. AssendelftAffiliated withDepartment of General Practice, Division of Public Health Academic Medical Center, University of Amsterdam
  • , Lex M. BouterAffiliated withInstitute for Research in Extramural Medicine, VU University Medical Center

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Abstract

Objective: Lateral epicondylitis is a common complaint, with an annual incidence between 1% and 3% in the general population. The Dutch College of General Practitioners in The Netherlands has issued guidelines that recommend a wait-and-see policy. However, these guidelines are not evidence based.

Design and setting: This paper presents the results of an economic evaluation in conjunction with a randomised controlled trial to evaluate the effects of three interventions in primary care for patients with lateral epicondylitis.

Patients and interventions: Patients with pain at the lateral side of the elbow were randomised to one of three interventions: a wait-and-see policy, corticosteroid injections or physiotherapy.

Main outcome measures and results: Clinical outcomes included general improvement, pain during the day, elbow disability and QOL. The economic evaluation was conducted from a societal perspective. Direct and indirect costs (in 1999 values) were measured by means of cost diaries over a period of 12 months. Differences in mean costs between groups were evaluated by applying non-parametric bootstrap techniques. The mean total costs per patient for corticosteroid injections were €430, compared with €631 for the wait-and-see policy and €921 for physiotherapy. After 12 months, the success rate in the physiotherapy group (91%) was significantly higher than in the injection group (69%), but only slightly higher than in the wait-and-see group (83%). The differences in costs and effects showed no dominance for any of the three groups. The incremental costutility ratios were (approximately): €7000 per utility gain for the wait-and-see policy versus corticosteroid injections; €12 000 per utility gain for physiotherapy versus corticosteroid injections, and €34 500 for physiotherapy versus the waitand- see policy.

Conclusions: The results of this economic evaluation provided no reason to update or amend the Dutch guidelines for GPs, which recommend a wait-and-see policy for patients with lateral epicondylitis.