Md Rafe Ansari, Aditi Popli, Renu Burathi
We read with interest the article by McClinton et al1 evaluating the cost-effectiveness of adding physical therapist treatment to usual podiatry care for plantar heel pain (PHP). The authors should be commended for conducting a long-term economic evaluation alongside a randomized clinical trial and for incorporating both societal and health care sector perspectives. Such analyses are valuable for informing interdisciplinary care decisions.1 Nevertheless, several methodological and statistical considerations warrant clarification to ensure appropriate interpretation of the reported findings.1 First, the economic evaluation was conducted on a relatively small sample (n = 95), which was further reduced in the per-protocol analysis. Economic evaluations are particularly sensitive to sample size due to the skewed and heterogeneous nature of cost data.2,3 Despite this, no a priori power calculation specific to economic outcomes such as costs, quality-adjusted life-years (QALYs), or incremental cost-effectiveness ratios (ICERs) was reported, raising concerns regarding the precision and stability of the cost-effectiveness estimates.