MS1: COST-EFFECTIVENESS OF INTERVENTIONS FOR LATERAL EPICONDYLITIS: RESULTS FROM A RANDOMIZED CONTROLLED TRIAL IN PRIMARY CARE

Abstract

OBJECTIVES: In 1997, the Dutch College of General Practitioners in the Netherlands issued guidelines which recommend a wait-and-see policy for patients with lateral epicondylitis. However, these guidelines are not evidence-based. This paper presents the results of an economic evaluation in conjunction with a randomized controlled trial to evaluate the effects of three interventions for patients with lateral epicondylitis. METHODS: 185 Patients with pain at the lateral side of the elbow were randomized to one of three interventions: a wait-and-see policy (n = 59), corticosteroid injections (n = 62) or physiotherapy (n = 64). Clinical outcomes included general improvement, pain during the day, elbow disability and quality of life (EuroQol). Direct and indirect costs 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. RESULTS: 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%). With regard to pain during the day and elbow disability, physiotherapy differed significantly over time, comparing to injection group, for these clinical outcomes. The mean total costs per patient for corticosteroid injections were Euro 430, compared to Euro 631 for the wait-and-see policy and Euro 921 for physiotherapy. These differences were statistically significant for corticosteroid injections compared to physiotherapy. The cost-effectiveness ratios showed no statistically significant differences between the three groups. The cost-utility ratio comparing physiotherapy and wait-and-see policy was 34,461 (1,982; 9,535,522); the other cost-utility ratios were not statistically significant. CONCLUSIONS: The results of this economic evaluation provide no reason to update or amend the Dutch guidelines for general practitioners, which recommend a wait-and-see policy for patients with lateral epicondylitis.