title: 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.
  
  
  OBJECTIVE
  The largest cost associated with treating tennis elbow is procedural intervention.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota sanders.thomas@mayo.edu.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Sanders
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Hilal
authors.initials: H
authors.lastname: Maradit Kremers
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bryan
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Ransom
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Morrey
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics; D000328:Adult; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D010342:Patient Acceptance of Health Care; D026741:Physical Therapy Modalities / Q000191:economics; D011859:Radiography / Q000191:economics; D012189:Retrospective Studies; D013716:Tennis Elbow / Q000191:economics* / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: cost; lateral elbow tendinosis; lateral epicondylitis; tennis elbow