Joost Peerbooms

76 Chapter 5 Table 4 Disability Resolution for the Corticosteroid (CS) and Platelet-Rich Plasma (PRP) Groups Disability Reduction Percentage Disability Reduction (%) a Time, wks Group n Average ± SE t >75% 50%-75% 25%-50% <25% x 2 4 CS 51 –33.8 ± 5.2 17.6 15.7 17.6 49.0 PRP 48 –24.6 ± 6.4 .42 4.2 12.5 29.2 54.2 .12 8 CS 51 –46.5 ± 6.7 29.4 9.8 17.6 43.1 PRP 48 –57.1 ± 8.7 .96 16.7 14.6 20.8 47.9 .48 12 CS 51 –39.0 ± 6.5 23.5 5.9 13.7 56.9 PRP 48 –68.5 ± 9.7 .03 27.1 20.8 18.8 33.3 .05 26 CS 51 –13.8 ± 7.7 13.7 7.8 11.8 66.7 PRP 49 –79.4 ± 11.8 < .001 38.8 14.3 14.3 32.7 .01 52 CS 50 –22.4 ± 8.6 24.0 12.0 14.0 50.0 PRP 49 –106.6 ± 8.7 <.001 57.1 4.1 14.3 24.5 .01 α For all patients, the disability reduction score is classified as > 75%, 50%-75%, 25%-50%, or < 25% disability reduction. For all time points, the percentage of patients in each category is calculated. The 2 groups are compared with the Chi-square test. Regarding the cost, PRP is not cost-effective when compared with corticosteroid on a short-term basis. A PRP treatment costs around €200 (current US$300, as of November 2009). The DBC price for injection treatment is €360 (US$540; DBC stands for Diagnose Behandeling Combinatie, or Diagnosis Treatment Combination). A DBC is an administrative code that combines diagnosis, treatment, and all the related costs; a DBC therefore includes all treatments per diagnosis, from the first visit to the last check- up. So, the overall cost for a PRP injection will be around €560 (US$840) compared with the corticosteroid injection of around €200 (US$300). But this does not include all socioeconomic costs. DISCUSSION This randomized study was designed to test the use of concentrated autologous platelets in patients with lateral epicondylitis; its application proved to be both safe and easy. The corticosteroid group was actually better initially and then declined, whereas the PRP group progressively improved. There was a significant difference in decrease of pain and disability of function following the platelet application after 26 weeks and 1 year. Lateral epicondylitis is a common problemwith many available treatment methods. The most commonly recommended treatment is physiotherapy and bracing. Approximately 87% of the patients benefit from this combination of treatment methods. 20