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Cost effectiveness of brace, physiotherapy, or both for treatment of tennis elbow
  1. P A A Struijs1,
  2. I B C Korthals-de Bos2,
  3. M W van Tulder2,
  4. C N van Dijk1,
  5. L M Bouter2,
  6. W J J Assendelft
  1. 1Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
  2. 2Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam
  1. Correspondence to:
 Dr Struijs
 Department of Orthopaedic Surgery, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, the Netherlands; paastruijs{at}


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.

  • tennis elbow
  • physiotherapy
  • cost analysis
  • injury
  • economics

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  • Published Online First 10 May 2006

  • Funding: The trial was financed by Buaerfeind, manufacturer of orthotic devices.

  • Competing interests: none declared