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An economic evaluation of TENS in addition to usual primary care management for the treatment of tennis elbow: results from the TATE randomized controlled trial
Lewis M, Chesterton LS, Sim J, Mallen CD, Hay EM, van der Windt DA
PLoS ONE 2015 Aug;10(8):e0135460
clinical trial
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The TATE trial was a multicentre pragmatic randomized controlled trial of supplementing primary care management (PCM)-consisting of a GP consultation followed by information and advice on exercises-with transcutaneous electrical nerve stimulation (TENS), to reduce pain intensity in patients with tennis elbow. This paper reports the health economic evaluation. METHODS AND FINDINGS: Adults with new diagnosis of tennis elbow were recruited from 38 general practices in the UK, and randomly allocated to PCM (n = 120) or PCM plus TENS (n = 121). Outcomes included reduction in pain intensity and quality-adjusted-life-years (QALYs) based on the EQ5D and SF6D. Two economic perspectives were evaluated: (i) healthcare-inclusive of NHS and private health costs for the tennis elbow; (ii) societal-healthcare costs plus productivity losses through work absenteeism. Mean outcome and cost differences between the groups were evaluated using a multiple imputed dataset as the base case evaluation, with uncertainty represented in cost-effectiveness planes and through probabilistic cost-effectiveness acceptability curves). Incremental healthcare cost was Great British Pounds 33 (95%CI -40 to 106) and societal cost Great British Pounds 65 (95%CI -307 to 176) for PCM plus TENS. Mean differences in outcome were: 0.11 (95%CI -0.13 to 0.35) for change in pain (0 to 10 pain scale); -0.015 (95%CI -0.058 to 0.029) for QALYEQ5D; 0.007 (95%CI -0.022 to 0.035) for QALYSF6D (higher score differences denote greater benefit for PCM plus TENS). The ICER (incremental cost effectiveness ratio) for the main evaluation of mean difference in societal cost (Great British Pounds) relative to mean difference in pain outcome was -582 (95%CI -8,666 to 8,113). However, incremental ICERs show differences in cost-effectiveness of additional TENS, according to the outcome being evaluated. CONCLUSION: Our findings do not provide evidence for or against the cost-effectiveness of TENS as an adjunct to primary care management of tennis elbow.

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