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dc.contributor.authorCoombes, Brooke K.en_US
dc.contributor.authorConnelly, Lukeen_US
dc.contributor.authorBisset, Leanneen_US
dc.contributor.authorVicenzino, Billen_US
dc.date.accessioned2018-11-13T12:30:47Z
dc.date.available2018-11-13T12:30:47Z
dc.date.issued2016en_US
dc.identifier.issn14730480en_US
dc.identifier.doi10.1136/bjsports-2015-094729en_US
dc.identifier.urihttp://hdl.handle.net/10072/149348
dc.description.abstractAim: 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.en_US
dc.description.peerreviewedYesen_US
dc.languageEnglishen_US
dc.publisherB M J Groupen_US
dc.publisher.placeUnited Kingdomen_US
dc.relation.ispartofpagefrom1400en_US
dc.relation.ispartofpageto1405en_US
dc.relation.ispartofjournalBritish Journal of Sports Medicineen_US
dc.relation.ispartofvolume50en_US
dc.subject.fieldofresearchPhysiotherapyen_US
dc.subject.fieldofresearchcode110317en_US
dc.titleEconomic evaluation favours physiotherapy but not corticosteroid injection as a first line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trialen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Peer Reviewed (HERDC)en_US
dc.type.codeC - Journal Articlesen_US
gro.description.notepublicThis publication has been entered into Griffith Research Online as an Advanced Online Version.en_US
gro.hasfulltextNo Full Text


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