title: Direct costs associated with the management of progressive early onset scoliosis: estimations based on gold standard technique or with magnetically controlled growing rods.
abstract: BACKGROUND
  The main disadvantage of the surgical management of early onset scoliosis (EOS) using conventional growing rods is the need for iterative surgical procedures during childhood. The emergence of an innovative device using distraction-based magnetically controlled growing rods (MCGR) provides the opportunity to avoid such surgeries and therefore to improve the patient's quality of life.
  
  
  OBJECTIVE
  Despite the high cost of MCGR and considering its potential impact in reducing hospital stays, the use of MCGR could reduce medical resource consumption in a long-term view in comparison to traditional growing rod (TGR).
  
  
  METHODS
  A cost-simulation model was constructed to assess the incremental cost between the two strategies. The cost for each strategy was estimated based on probability of medical resource consumption determined from literature search as well as data from EOS patients treated in our centre. Some medical expenses were also estimated from expert interviews. The time horizon chosen was 4 years as from first surgical implantation. Costs were calculated in the perspective of the French sickness fund (using rates from year 2013) and were discounted by an annual rate of 4%. Sensitivity analyses were conducted to test model strength to various parameters.
  
  
  RESULTS
  With a time horizon of 4 years, the estimated direct costs of TGR and MCGR strategies were 49,067 € and 42,752 €, respectively leading to an incremental costs of 6135 € in favour of MCGR strategy. In the first case, costs were mainly represented by hospital stays expenses (83.9%) whereas in the other the cost of MCGR contributed to 59.5% of the total amount. In the univariate sensitivity analysis, the tariffs of hospital stays, the tariffs of the MCG, and the frequency of distraction surgeries were the parameters with the most important impact on incremental cost.
  
  
  CONCLUSIONS
  MCGR is a recent and promising innovation in the management of severe EOS. Besides improving the quality of life, its use in the treatment of severe EOS is likely to be offset by lower costs of hospital stays.
  Level IV, economic and decision analyses, retrospective study.
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Service Pharmaceutique, avenue du Doyen-Lépine, 69500 Bron, France.
authors.forename: C
authors.initials: C
authors.lastname: Charroin
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Service Chirurgie Orthopédique pédiatrique, Université Claude-Bernard Lyon 1, avenue du Doyen-Lépine, 69500 Bron, France.
authors.forename: K
authors.initials: K
authors.lastname: Abelin-Genevois
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Service Chirurgie Orthopédique pédiatrique, Université Claude-Bernard Lyon 1, avenue du Doyen-Lépine, 69500 Bron, France.
authors.forename: V
authors.initials: V
authors.lastname: Cunin
authors.affiliation: Pôle information médicale évaluation recherche, équipe d'accueil 4129, hospices civils de Lyon et université de Lyon, 59, boulevard Pinel, 69677 Bron, France; Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, 59, boulevard Pinel, 69677 Bron, France.
authors.forename: J
authors.initials: J
authors.lastname: Berthiller
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Service Pharmaceutique, avenue du Doyen-Lépine, 69500 Bron, France.
authors.forename: H
authors.initials: H
authors.lastname: Constant
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Service Chirurgie Orthopédique pédiatrique, Université Claude-Bernard Lyon 1, avenue du Doyen-Lépine, 69500 Bron, France.
authors.forename: R
authors.initials: R
authors.lastname: Kohler
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Est, Service Pharmaceutique, avenue du Doyen-Lépine, 69500 Bron, France; Université Claude-Bernard Lyon 1, UMR-CNRS 5510/MATEIS, Bron, France.
authors.forename: G
authors.initials: G
authors.lastname: Aulagner
authors.affiliation: Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, 59, boulevard Pinel, 69677 Bron, France.
authors.forename: H
authors.initials: H
authors.lastname: Serrier
authors.affiliation: Université Claude-Bernard Lyon 1, UMR-CNRS 5510/MATEIS, Bron, France; Hospices Civils de Lyon, Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation, avenue du Doyen-Lépine, 69500 Bron, France. Electronic address: xavier.armoiry@chu-lyon.fr.
authors.forename: X
authors.initials: X
authors.lastname: Armoiry
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D005602:France; D006760:Hospitalization / Q000191:economics; D006801:Humans; D018803:Models, Economic; D019736:Prostheses and Implants / Q000191:economics*; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics* / Q000601:surgery*
keywords: Direct costs; Early onset scoliosis; Magnetically controlled growing rods; Spinal growing rods