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An Institutional and Nationally-Extrapolated Cost Analysis of Surgical and Nonsurgical Management of Lateral Epicondylitis
Anthony Fillmore, MD1; Kyongsei Sohn, PhD2; Thomas F. Breen, MD1; Edward R. Calkins, MD1;
1UMass Memorial Medical Center, 2State University of New York, The College at Brockport

Introduction: Inevitably, healthcare costs will be capped either by markets or by fiat relative to the size of the overall economy. Ideally, government will act to maximize societal welfare within the constraints of the healthcare allocation. Surgeons can influence resource allocation when treatment costs relative to outcomes are critically assessed.

This study compares the direct medical costs of surgical versus nonsurgical management of lateral epicondylitis in patients with symptoms under 12 months. Since lateral epicondylitis is usually a self-limiting condition, treatment costs should be scrutinized for opportunities to economize. This is not a cost-benefit analysis, but rather a retrospective analysis of relative costs between treatment programs to assess whether the magnitude of cost difference justifies a prospective cost-benefit analysis.

Materials & Methods: Between 1/1/2009 and 12/31/2010, 332 patients with a diagnosis of lateral epicondylitis were evaluated. Two senior surgeons with differing treatment paradigms relative to the role of surgical intervention treated the patients. Electronic medical records were reviewed. Two hundred forty-six (246) patients met the inclusion criteria for this review. Direct medical care costs for each patient were determined by using the 2011 Medicare Physician Fee Schedule and the 2011 Medicare Hospital Outpatient/Ambulatory Surgery Center Fee Schedule. Data analysis and extrapolation to estimate national direct medical care costs for the treatment of lateral epicondylitis was performed. Criteria for the national costs extrapolation were developed from the available literature.

Results: The total direct medical care cost for 189 patients treated non-operatively was \,664 (mean cost \/patient). The total direct medical care cost for the 57 patients treated surgically was \,836 (mean cost \,769/patient). The total direct medical care costs for the entire group was \,500. Based on a low to medium prevalence rate ranging from 1% to 2% with 40% of affected individuals seeking medical attention and a 20% rate of surgical treatment, national direct medical care cost are estimated to range between \ million and \.3 billion annually for the treatment of lateral epicondylitis.

Conclusions: The treatment of lateral epicondylitis, a usually self-limiting condition, results in large aggregate expenses to the healthcare allocation of our national economy. Surgical treatment generates a disproportionate percentage of these costs. Additional studies, including a prospective cost-benefit analysis, are necessary.

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