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Cost-Effectiveness of Platelet-Rich Plasma Versus Corticosteroid Injections for the Treatment of Recalcitrant Lateral Epicondylitis: A Markov/Monte Carlo Analysis
Kevin M. Klifto, DO, PharmD, University of Missouri, Columbia, MO, Stephen H. Colbert, MD, M349, Division of Plastic, University of Missouri, Columbia, MO, Oke Anakwenze, MD, MBA, Duke University Medical Center, Durham, NC, Marc J Richard, MD, Orthopedic Surgery, Duke University Medical Center, Durham, NC, David S Ruch, MD, Duke University, Durham, NC and Christopher Klifto, MD, Duke Univeristy Hospital, Durham, NC

Background: Both platelet-rich plasma (PRP) and corticosteroid injections may be used to treat lateral epicondylitis. We evaluated the cost-effectiveness of PRP injections versus corticosteroid injections for the treatment of recalcitrant lateral epicondylitis.
Methods: Markov modeling was used to analyze the base-case 45-year-old patient with recalcitrant lateral epicondylitis, unresponsive to conservative measures, treated with a single injection of PRP or triamcinolone 40mg/mL. Transition probabilities were derived from 8 randomized controlled trials, quality-of-life (QOL) values from the Tufts University Cost-Effectiveness Analysis Registry reported with visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores, and costs from Medicare reimbursement schedules, published studies, and industry. Analyses were performed from healthcare and societal perspectives. Outcomes were incremental cost-effectiveness ratios (ICER), reported as United States Dollars/quality-adjusted-life-years (USD/QALY) and net monetary benefits (NMB). Willingness-to-pay thresholds were set at $50,000 and $100,000. Deterministic and probabilistic sensitivity analyses were performed over 10,000 iterations.
Results: From a healthcare perspective, compared to triamcinolone 40mg/mL injections, the ICER for PRP injections measured by VAS was $25.51/QALY and DASH was $25.73/QALY. PRP injections provided a NMB measured by VAS of $1,500,693.38 and DASH of $1,513,349.59, compared to a NMB measured by VAS of $1,380,755.82 and DASH of $1,394,398.76. From a societal perspective, compared to PRP injections, the ICER for triamcinolone 40mg/mL injections measured by VAS was -$463.55/QALY and DASH was -$467.39/QALY. PRP injections provided a NMB measured by VAS of $1,497,494.18 and DASH of $1,510,150.39, compared to a NMB measured by VAS of $1,376,382.89 and DASH of $1,390,025.83.
Conclusions: Both PRP and triamcinolone 40mg/mL injections provided cost-effective treatments from a healthcare perspective, while PRP injections provided cost-effective treatment from a societal perspective. Overall, PRP injections provided the most cost-effective treatment for recalcitrant lateral epicondylitis from both healthcare and societal perspectives.
Level of Evidence: Economic Level-II


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