Health Care Utilization and Direct Medical Costs of Tennis Elbow: A Population-Based Study

Abstract

Background: Tennis elbow is commonly encountered by physicians, yet little is known about the cost of treating this condition.

Hypothesis: The largest cost associated with treating tennis elbow is procedural intervention.

Study design: Descriptive epidemiology study.

Level of evidence: Level 4.

Methods: This retrospective population-based study reviewed patients who were treated for new-onset tennis elbow between January 1, 2003 and December 31, 2012. All patients were followed up through their medical and administrative records to identify health care encounters and interventions for tennis elbow. Unit costs for each health service/procedure were adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars.

Results: In a cohort of 931 patients who had 2 or more clinical encounters for new-onset lateral epicondylosis during a 12-month period after initial diagnosis, 62% received a median of 3 physical therapy sessions (cost, $100/session) and 40% received a median of 1 steroid injection (cost, $82/injection). Only 4% of patients received surgical intervention with mean costs of $4000. The mean (median) total direct medical cost of services related to lateral epicondylosis for the entire cohort was $660 ($402) per patient over the 1-year period after diagnosis. Patients who continued to be treated conservatively between 6 and 12 months after diagnosis incurred relatively low median costs of $168 per patient.

Conclusion: In this cohort, a second encounter with a physician for tennis elbow was a strong predictor of increased treatment cost due to a higher likelihood of specialist referral, use of physical therapy, or treatment with steroid injection.

Clinical relevance: The majority of direct medical spending on tennis elbow occurs within the first 6 months of treatment, and relatively little expense occurs between 6 and 12 months after diagnosis unless a patient undergoes surgical intervention.

Keywords: cost; lateral elbow tendinosis; lateral epicondylitis; tennis elbow.

Figure 1.

Percentage of annual direct medical costs of treating tennis elbow in a hypothetical cohort of 100 patients with at least 2 clinical encounters by service provided. MRI, magnetic resonance imaging.