Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care

Pharmacoeconomics. 2004;22(3):185-95. doi: 10.2165/00019053-200422030-00004.


Objective: Lateral epicondylitis is a common complaint, with an annual incidence between 1% and 3% in the general population. The Dutch College of General Practitioners in The Netherlands has issued guidelines that recommend a wait-and-see policy. However, these guidelines are not evidence based.

Design and setting: This paper presents the results of an economic evaluation in conjunction with a randomised controlled trial to evaluate the effects of three interventions in primary care for patients with lateral epicondylitis.

Patients and interventions: Patients with pain at the lateral side of the elbow were randomised to one of three interventions: a wait-and-see policy, corticosteroid injections or physiotherapy.

Main outcome measures and results: Clinical outcomes included general improvement, pain during the day, elbow disability and QOL. The economic evaluation was conducted from a societal perspective. Direct and indirect costs (in 1999 values) were measured by means of cost diaries over a period of 12 months. Differences in mean costs between groups were evaluated by applying non-parametric bootstrap techniques. The mean total costs per patient for corticosteroid injections were euro430, compared with euro631 for the wait-and-see policy and euro921 for physiotherapy. After 12 months, the success rate in the physiotherapy group (91%) was significantly higher than in the injection group (69%), but only slightly higher than in the wait-and-see group (83%). The differences in costs and effects showed no dominance for any of the three groups. The incremental cost-utility ratios were (approximately): euro7000 per utility gain for the wait-and-see policy versus corticosteroid injections; euro12000 per utility gain for physiotherapy versus corticosteroid injections, and euro34500 for physiotherapy versus the wait-and-see policy.

Conclusions: The results of this economic evaluation provided no reason to update or amend the Dutch guidelines for GPs, which recommend a wait-and-see policy for patients with lateral epicondylitis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / economics*
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Anesthetics, Local / economics
  • Anesthetics, Local / therapeutic use
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Health Care Costs*
  • Health Services Research
  • Humans
  • Injections, Intradermal / economics
  • Injections, Intradermal / statistics & numerical data
  • Lidocaine / economics
  • Lidocaine / therapeutic use
  • Middle Aged
  • Netherlands
  • Observation
  • Physical Therapy Modalities / economics*
  • Physical Therapy Modalities / statistics & numerical data
  • Primary Health Care / economics*
  • Primary Health Care / methods
  • Tennis Elbow / economics*
  • Tennis Elbow / therapy*
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anesthetics, Local
  • Lidocaine