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Cost effectiveness of brace, physiotherapy, or both for treatment of tennis elbow

2006; BMJ; Volume: 40; Issue: 7 Linguagem: Inglês

10.1136/bjsm.2006.026187

1473-0480

Peter Struijs, Ingeborg B. C. Korthals–de Bos, Maurits W. van Tulder, C. N. van Dijk, L.M. Bouter, Willem JJ Assendelft,

Shoulder Injury and Treatment

Background: The annual incidence of tennis elbow in the general population is high (1–3%). Tennis elbow often leads to limitation of activities of daily living and work absenteeism. Physiotherapy and braces are the most common treatments. Objectives: The hypothesis of the trial was that no difference exists in the cost effectiveness of physiotherapy, braces, and a combination of the two for treatment of tennis elbow. Methods: The trial was designed as a randomised controlled trial with intention to treat analysis. A total of 180 patients with tennis elbow were randomised to brace only (n = 68), physiotherapy (n = 56), or a combination of the two (n = 56). Outcome measures were success rate, severity of complaints, pain, functional disability, and quality of life. Follow up was at six, 26, and 52 weeks. Direct healthcare and non-healthcare costs and indirect costs were measured. Mean cost differences over 12 months were evaluated by applying non-parametric bootstrap techniques. Results: No clinically relevant or statistically significant differences were found between the groups. Success rate at 12 months was 89% in the physiotherapy group, 86% in the brace group, and 87% in the combination group. Mean total costs per patient were €2069 in the brace only group, €978 in the physiotherapy group, and €1256 in the combination group. The mean difference in total costs between the physiotherapy and brace group was substantial (€1005), although not significant. Cost effectiveness ratios and cost utility ratios showed physiotherapy to be the most cost effective, although this also was not statistically significant. Conclusion: No clinically relevant or statistically significant differences in costs were identified between the three strategies.