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

Authors: P A A Struijs, I B C Korthals-de Bos, M W van Tulder, C N van Dijk, L M Bouter, W J J Assendelft, and B M Pluim

References: Br J Sports Med 2006; 40: 637-643

Abstract
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.

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