Epidemiology and Disease Burden of Lateral Epicondylitis in the USA: Analysis of 85,318 Patients

Abstract

Background: National rates of lateral epicondylitis and surgical treatment are poorly defined. Disease burden of lateral epicondylitis (LE) continues to increase annually. Further study is necessary to optimize treatment algorithms to reduce associated health-care expenditures.

Questions/purposes: The purpose of this study is to review the annual incidence of LE, surgical rates, and associated health-care costs in a population setting.

Methods: A national database was queried for LE from 2007 to 2014. Surgical cases were identified and annual rates were recorded. Demographic and epidemiologic data were reported with descriptive statistics, while trends over time were analyzed using linear regression.

Results: Eighty-five thousand three hundred eighteen cases of LE were identified. The annual incidence per 10,000 patients remained constant (p = 0.304). The proportion of diagnoses in patients <65 years decreased (p ≤ 0.002) and ≥65 years increased (p < 0.001) over the study period. One thousand six hundred ninety-four patients (2%) required operative treatment. The annual rate of surgical intervention remained constant (p = 0.623). The proportion of patients <40 years requiring surgery decreased (p < 0.001) as the proportion of patients ≥65 years needing surgery increased (p = 0.003). Total reimbursement for LE procedures during the study period was $7,220,912. Average per-patient reimbursement was $4263. Both annual total reimbursement (p = 0.006) and per-patient reimbursement rates (p = 0.002) significantly increased.

Conclusion: The annual incidence of LE and rate of surgical intervention have remained constant from 2007 to 2014. The proportion of patients over >65 years diagnosed with, and receiving surgical treatment for, LE has significantly increased in recent years. Total reimbursement and average per-patient reimbursement have steadily risen, demonstrating the increasing burden of cost on the health-care system.

Keywords: cost; epidemiology; incidence; lateral epicondylitis; tennis elbow.

Conflict of interest statement

Compliance with Ethical StandardsRyan M. Degen, MD; Matthew S. Conti, MD; Christopher L. Camp, MD; David W. Altchek, MD; and Brian C. Werner, MD, have declared that they have no conflict of interest. Joshua S. Dines, MD, reports personal fees from Arthrex, Conmed Linvatec, and Ossur, outside the work.All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).Informed consent was waived from all patients for being included in the study.Disclosure forms provided by the authors are available with the online version of this article.

Figures

Fig. 1

Total annual reimbursement for lateral epicondylitis surgery from 2007 to 2014.

Fig. 2

Annual per-patient reimbursement for lateral epicondylitis surgery from 2007 to 2014.