经济评估倾向于选择物理治疗而非皮质类固醇注射作为慢性外上髁炎的一线干预措施：来自一项随机临床试验的证据。

Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial.

机构信息

The University of Queensland, School of Biomedical Sciences, Brisbane, Queensland, Australia.

The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, Queensland, Australia.

出版信息

Br J Sports Med. 2016 Nov;50(22):1400-1405. doi: 10.1136/bjsports-2015-094729. Epub 2015 Jun 2.

DOI:10.1136/bjsports-2015-094729

PMID:26036675

Abstract

AIM

To determine the cost-effectiveness of corticosteroid injection, physiotherapy and a combination of these interventions, compared to a reference group receiving a blinded placebo injection.

METHODS

165 adults with unilateral lateral epicondylalgia of longer than 6 weeks duration from Brisbane, Australia, were randomised for concealed allocation to saline injection (placebo), corticosteroid injection, saline injection plus physiotherapy (eight sessions of elbow manipulation and exercise) or corticosteroid injection plus physiotherapy. Costs to society and health-related quality of life (estimated by EuroQol-5D) over the 1 year follow-up were used to generate incremental cost per quality-adjusted life year (QALY) ratios for each intervention relative to placebo.

RESULTS

Intention-to-treat analysis was possible for 154 (93%) of trial participants. Physiotherapy was more costly, but was the only intervention that produced a statistically significant improvement in quality of life relative to placebo (MD, 95% CI 0.035, 0.003 to 0.068). Similar cost/QALY ratios were found for physiotherapy ($A29 343; GBP18 962) and corticosteroid injection ($A31 750; GBP20 518); however, the probability of being more cost-effective than placebo at values above $A50 000 per quality-adjusted life year was 81% for physiotherapy and 53% for corticosteroid injection. Cost/QALY was far greater for a combination of corticosteroid injection and physiotherapy ($A228 000; GBP147 340).

SUMMARY

Physiotherapy was a cost-effective treatment for lateral epicondylalgia. Corticosteroid injection was associated with greater variability, and a lower probability of being cost-effective if a willingness to pay threshold of $A50 000 is assumed. A combination of corticosteroid injection and physiotherapy was ineffective and cost-ineffective. Physiotherapy, not corticosteroid injection, should be considered as a first-line intervention for lateral epicondylalgia.

TRIAL REGISTRATION NUMBER

anzctr.org Trial identifier: ACTRN12609000051246.

摘要

目的

确定皮质类固醇注射、物理治疗以及这些干预措施的组合与接受盲法安慰剂注射的参照组相比的成本效益。

方法

来自澳大利亚布里斯班的 165 名单侧桡侧伸肌腱炎患者，病程超过 6 周，随机分组接受隐匿性分配，接受盐水注射（安慰剂）、皮质类固醇注射、盐水注射加物理治疗（8 次肘部推拿和运动）或皮质类固醇注射加物理治疗。在 1 年的随访中，使用社会成本和健康相关生活质量（通过 EuroQol-5D 评估）来生成每种干预措施相对于安慰剂的增量成本效益比（每质量调整生命年的成本）。

结果

154 名（93%）试验参与者可进行意向治疗分析。物理治疗费用更高，但与安慰剂相比，是唯一能显著改善生活质量的干预措施（MD，95%CI 0.035，0.003 至 0.068）。物理治疗（A$29343；£18962）和皮质类固醇注射（A$31750；£20518）的成本效益比相似；然而，假设每质量调整生命年支付意愿阈值为 A$50000 以上，物理治疗的成本效益比更有可能（81%），皮质类固醇注射的成本效益比更有可能（53%）。皮质类固醇注射加物理治疗的成本效益比更高（A$228000；£147340）。