Struijs P A A, Korthals-de Bos I B C, van Tulder M W, van Dijk C N, Bouter L M, Assendelft W J J
Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Br J Sports Med. 2006 Jul;40(7):637-43; discussion 643. doi: 10.1136/bjsm.2006.026187. Epub 2006 May 10.
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.
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.
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.
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 euros in the brace only group, 978 euros in the physiotherapy group, and 1256 euros in the combination group. The mean difference in total costs between the physiotherapy and brace group was substantial (1005 euros), 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.
No clinically relevant or statistically significant differences in costs were identified between the three strategies.
普通人群中网球肘的年发病率较高（1%-3%）。网球肘常导致日常生活活动受限和工作缺勤。物理治疗和支具是最常见的治疗方法。
该试验的假设是，物理治疗、支具以及两者联合治疗网球肘在成本效益方面不存在差异。
该试验设计为一项意向性分析的随机对照试验。共有180例网球肘患者被随机分为仅使用支具组（n = 68）、物理治疗组（n = 56）或两者联合组（n = 56）。结局指标包括成功率、症状严重程度、疼痛、功能障碍和生活质量。随访时间为6周、26周和52周。测量直接医疗和非医疗成本以及间接成本。通过应用非参数自助法技术评估12个月内的平均成本差异。
各组之间未发现临床相关或统计学上的显著差异。物理治疗组12个月时的成功率为89%，支具组为86%，联合组为87%。仅使用支具组每位患者的平均总成本为2069欧元，物理治疗组为978欧元，联合组为1256欧元。物理治疗组和支具组之间的总成本平均差异较大（1005欧元），尽管不显著。成本效益比和成本效用比显示物理治疗是最具成本效益的，尽管这也无统计学意义。
三种治疗策略在成本方面未发现临床相关或统计学上的显著差异。
