title: A health economic evaluation of screening and treatment in patients with adolescent idiopathic scoliosis.
abstract: BACKGROUND
  Adolescent idiopathic scoliosis can progress and affect the health related quality of life of the patients. Research shows that screening is effective in early detection, which allows for bracing and reduced surgical rates, and may save costs, but is still controversial from a health economic perspective.
  
  
  METHODS
  Model based cost minimisation analysis using hospital's costs, administrative data, and market prices to estimate costs in screening, bracing and surgical treatment. Uncertainty was characterised by deterministic and probabilistic sensitivity analyses. Time horizon was 6 years from first screening at 11 years of age.
  
  
  OBJECTIVE
  To compare estimated costs in screening and non-screening scenarios (reduced treatment rates of 90%, 80%, 70% of screening, and non-screening Norway 2012).
  
  
  METHODS
  Data was based on screening and treatment costs in primary health care and in hospital care settings. Participants were 4000, 12-year old children screened in Norway, 115190 children screened in Hong Kong and 112 children treated for scoliosis in Norway in 2012. We assumed equivalent outcome of health related quality of life, and compared only relative costs in screening and non-screening settings. Incremental cost was defined as positive when a non-screening scenario was more expensive relative to screening.
  
  
  RESULTS
  Screening per child was € 8.4 (95% CrI 6.6 to10.6), € 10350 (8690 to 12180) per patient braced, and € 45880 (39040 to 55400) per child operated. Incremental cost per child in non-screening scenario of 90% treatment rate was € 13.3 (1 to 27), increasing from € 1.3 (-8 to 11) to € 27.6 (14 to 44) as surgical rates relative to bracing increased from 40% to 80%. For the 80% treatment rate non-screening scenario, incremental cost was € 5.5 (-6 to 18) when screening all, and € 11.3 (2 to 22) when screening girls only. For the non-screening Norwegian scenario, incremental cost per child was € -0.1(-14 to 16). Bracing and surgery were the main cost drivers and contributed most to uncertainty.
  
  
  CONCLUSIONS
  With the assumptions applied in the present study, screening is cost saving when performed in girls only, and when it leads to reduced treatment rates. Cost of surgery was dominating in non-screening whilst cost of bracing was dominating in screening. The economic gain of screening increases when it leads to higher rates of bracing and reduced surgical rates.
authors.affiliation: Section for Spine Surgery, Department of Orthopedic Surgery, Oslo University Hospital-Rikshospitalet, Pb 4950, Nydalen, N-0424 Oslo, Norway.
authors.forename: Raphael D
authors.initials: RD
authors.lastname: Adobor
authors.affiliation: Oslo and Akershus University College of Applied Sciences, P. O Box 4, St. Olavs plass, N-0130 Oslo, Norway ; School of Economics and Business, Norwegian University of Life Sciences, P. O. Box 5003, N-1432 Ås, Norway.
authors.forename: Paal
authors.initials: P
authors.lastname: Joranger
authors.affiliation: Oslo and Akershus University College of Applied Sciences, P. O Box 4, St. Olavs plass, N-0130 Oslo, Norway ; Biomechanic lab, Department of Orthopedic Surgery, Oslo University Hospital-Rikshospitalet, Pb 4950, Nydalen, N-0424 Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Steen
authors.affiliation: School of Economics and Business, Norwegian University of Life Sciences, P. O. Box 5003, N-1432 Ås, Norway.
authors.forename: Ståle
authors.initials: S
authors.lastname: Navrud
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Pb 4950, Nydalen, N-0424 Oslo, Norway.
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Brox
keywords: Cost minimisation analysis; Health related quality of life; Scoliosis screening; Scoliosis treatment