Cost-Effectiveness of Two Dry Needling Interventions for Plantar Heel Pain: A Secondary Analysis of an RCT

Abstract

Plantar heel pain is a common cause of foot pain that affects patients’ quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN.

A comparative study of treatment interventions for patellar tendinopathy: a secondary cost-effectiveness analysis

“…To our knowledge, there are no other publications that have analysed the cost-effectiveness of these techniques in patients with PT. However, other studies showed similar results in the comparison of PNE versus DN in the treatment of plantar heel pain, 21 with PNE having an 83% probability of being cost-effective against DN, similar to our study that showed a probability of 93%. In the case of the comparison of DN versus sham needling, we observed that the results were not in favour of DN as suggested by Arias-Buría et al, 42 who found DN to be dominant over control in subacromial pain syndrome.…”

“…The economic evaluation was conducted from the perspective of a hospital, clinic or health centre. Direct health care costs such as the needling material (sterile gauze, antiseptic solution, US gel, needles), 29,30 the US and PNE device 31 and the staff (physiotherapist) 21 were calculated. The cost of both US and PNE devices was assessed considering the average cost of the equipment (5 or 10 years of amortisation of the equipment cost), the average number of uses per year, and the cost of maintenance, following the guidelines of the Spanish Society of Ultrasound (SEUS) in the case of the US and the approximate cost of the equipment according to market distributor prices.…”

“…In addition, there are few studies on the cost-effectiveness of minimally invasive therapies. 20–22 One of them compared the cost-effectiveness of two different minimally invasive treatments for plantar heel pain provoked by myofascial trigger points and concluded that PNE had a better cost-effectiveness ratio than DN. Another study, performed in patients with lateral elbow tendinopathy, compared the cost-effectiveness of PNE with other surgical treatments and concluded that treatment with PNE combined with EE and stretching constitutes a treatment with a very acceptable cost-effectiveness ratio.…”

Ultrasound-Guided Percutaneous Neuromodulation in Multiple Sclerosis: A Case Report

“…However, it also has some limitations, which impede the generalization of results, as this is a case report and does not have a control. In this study, it was only analyzed the effects of a single session of PN, and therefore it is necessary that future studies analyze the effects of different number of PN sessions and the cost-effectiveness of them, similarly to what has been performed in other studies related to tendinous injuries, 18 myofascial pain 19 and spasticity, 20 , 21 or compared to pharmacological alternatives such as BTX A. 22 Moreover, future studies should be developed with larger samples and with other neurological populations, analyzing also the effect of PN as part of a multimodal treatment, in order to understand which is the additional improvement that PN may achieve in patients with neurological impairments.…”

Dry Needling and Antithrombotic Drugs

“…Worldwide, clinicians are using dry needling (DN) to reduce pain [1,2], increase range of motion and flexibility [3], enhance performance [4], reduce spasticity [5], or improve fascial and scar tissue mobility [6,7]. Dry needling is a safe and cost-effective treatment approach [8][9][10][11], but there is no literature informing clinicians whether DN can be applied safely in patients with altered coagulation. Potentially, patients taking antithrombotic drugs may have an increased risk of suffering bleeding complications when being treated with DN.…”