Cost-effectiveness of brace, physical therapy or both, for treatment of tennis elbow

Peter AA Struijs ^1*, Ingeborg BC Korthals-de Bos ², Maurits W van Tulder ², CN van Dijk ¹, Lex M Bouter ² and Willem JJ Assendelft ²

¹ Academic Medical Center, Netherlands
² EMGO Institute, Netherlands

^* To whom correspondence should be addressed. E-mail: paastruijs{at}hotmail.com.

Accepted 9 April 2006

Abstract

Background Tennis elbow has a high incidence and will often lead to severe limitations in daily life activities and work absenteeism. Physical therapy and braces are frequently prescribed treatment strategies.

Objectives The hypothesis of the trial was that no difference exists in the cost-effectiveness of physical therapy, braces and the combination of both for treatment of tennis elbow.

Methods The trial was designed as a randomised controlled trial with intention-to-treat analysis. One hundred-eighty patients with tennis elbow were randomised to either brace-only, physical therapy or the combination of both. Outcome measures used were success- rate, severity of complaints, pain, functional disability and quality of life. Direct health care and direct non-health care costs, as well as indirect costs were measured. Mean costs differences over 12-months were evaluated by applying non-parametric bootstrap techniques.

Results No clinically relevant nor statistically significant differences were found between groups. Success rate at 12 months was 89% in the physical therapy group, compared to 86% and 87% in the brace and combination group. Mean total costs per patient were 2,069 in the brace-only, 978 in the physical therapy and 1,256 in the combination group. The mean difference in total costs between the physical therapy and brace group was substantial (1005), although not significant. The cost effectiveness ratios and cost utility ratios showed physical therapy to be the most cost-effective, though also not statistically significant.

Conclusion No clinically relevant differences were identified. Physical therapy treatment showed considerably lower costs compared to brace-only, although not significant.

Key Words: Cost analysis, Economics, Sports injury, Tennis elbow, Therapy

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