Cost Effectiveness of Interventions for Lateral Epicondylitis
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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.
- 2.Verhaar JA. Tennis elbow [thesis]. Maastricht: University Press, 1992Google Scholar
- 4.Murtagh JE. Tennis elbow. Aust Fam Physician 1988; 17: 90, 91, 94–5Google Scholar
- 7.Labelle H, Guibert R, Joncas J, et al. Lack of scientific evidence for the treatment of lateral epicondylitis of the elbow: an attempted meta-analysis. J Bone Joint Surg 1992; 74B: 646–51Google Scholar
- 8.Assendelft WJ, Rikken SA, Mel M, et al. NHG practice guideline for epicondylitis [in Dutch]. Huisarts Wet 1997; 40: 21–6Google Scholar
- 9.Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. New York: Oxford Medical Publications, 1997Google Scholar
- 10.Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. Oxford: Oxford University Press, 1996Google Scholar
- 13.Stratford P, Levy DR, Levy K, et al. Extensor carpi radialis tendonitis: a validation of selected outcome measures. Physiother Can 1987; 39: 250–5Google Scholar
- 15.Kind P. The Euroqol Instrument: an index of health-related quality of life. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Philadelphia: Lippincott-Raven, 1996: 191–201Google Scholar
- 18.Oostenbrink JB, Koopmanschap MA, Rutten FF. Handbook for cost studies, methods and guidelines for economic evaluation in health care [in Dutch]. Amstelveen: Health Care Insurance Council, 2000Google Scholar
- 20.Dutch Central Organisation for Health Care Charges. Tariffs for medical specialist, excluding psychiatrics: supplement to tariffs decision number 5600–1900-97–1 from 21 oktober 1996 [in Dutch]. Utrecht: Dutch Central Organisation for Health Care Charges, 1996Google Scholar
- 21.Taxe report [in Dutch]. The Hague: Z-index, 2000Google Scholar
- 23.Koopmanschap MA, Rutten FF. Indirect costs: the consequence of production loss or increased costs of production. Med Care 1996; 34: DS59–68Google Scholar
- 25.Efron B, Tibshirani RJ. An introduction to the bootstrap. New York: Chapman & Hall, 1993Google Scholar
- 33.Desgagn´e A, Castilloux AM, Angers JF, et al. The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data. Pharmacoeconomics 1998; 13 (5): 487–97Google Scholar