Cost analysis of magnetically controlled growing rods compared with traditional growing rods for early-onset scoliosis in the US: an integrated health care delivery system perspective.
OBJECTIVE
Traditional growing rod (TGR) for early-onset scoliosis (EOS) is effective but requires repeated invasive surgical lengthenings under general anesthesia. Magnetically controlled growing rod (MCGR) is lengthened noninvasively using a hand-held magnetic external remote controller in a physician office; however, the MCGR implant is expensive, and the cumulative cost savings have not been well studied. We compared direct medical costs of MCGR and TGR for EOS from the US integrated health care delivery system perspective. We hypothesized that over time, the MCGR implant cost will be offset by eliminating repeated TGR surgical lengthenings.


METHODS
For both TGR and MCGR, the economic model estimated the cumulative costs for initial implantation, lengthenings, revisions due to device failure, surgical-site infections, device exchanges (at 3.8 years), and final fusion, over a 6-year episode of care. Model parameters were estimated from published literature, a multicenter EOS database of US institutions, and interviews. Costs were discounted at 3.0% annually and represent 2015 US dollars.


RESULTS
Of 1,000 simulated patients over 6 years, MCGR was associated with an estimated 270 fewer deep surgical-site infections and 197 fewer revisions due to device failure compared with TGR. MCGR was projected to cost an additional $61 per patient over the 6-year episode of care compared with TGR. Sensitivity analyses indicated that the results were sensitive to changes in the percentage of MCGR dual rod use, months between TGR lengthenings, percentage of hospital inpatient (vs outpatient) TGR lengthenings, and MCGR implant cost.


CONCLUSIONS
Cost neutrality of MCGR to TGR was achieved over the 6-year episode of care by eliminating repeated TGR surgical lengthenings. To our knowledge, this is the first cost analysis comparing MCGR to TGR - from the US provider perspective - which demonstrates the efficient provision of care with MCGR.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
David W
DW
Polly
Covance Market Access Services Inc., San Diego, CA, USA.
Stacey J
SJ
Ackerman
Covance Market Access Services Inc., Sydney, Australia.
Karen
K
Schneider
San Diego Spine Foundation, San Diego, CA, USA.
Jeff B
JB
Pawelek
San Diego Spine Foundation, San Diego, CA, USA.
Behrooz A
BA
Akbarnia
cost analysis; early-onset scoliosis; economic model; magnetically controlled growing rods; traditional growing rods
Spine (Phila Pa 1976). 2005 Sep 1;30(17 Suppl):S46-57
16138066
Spine J. 2005 Sep-Oct;5(5):520-8; discussion 529
16153580
Spine (Phila Pa 1976). 2005 Sep 15;30(18):2039-44
16166892
J Bone Joint Surg Am. 2010 Nov 3;92(15):2533-43
20889912
Spine (Phila Pa 1976). 2010 Dec 1;35(25):2252-8
21102301
Spine (Phila Pa 1976). 2011 Jul 15;36(16):1305-11
21730818
Spine (Phila Pa 1976). 2012 Jun 1;37(13):1109-14
22146279
Spine (Phila Pa 1976). 2012 Jul 1;37(15):1303-9
22210014
Curr Rev Musculoskelet Med. 2012 Jun;5(2):102-10
22477364
Lancet. 2012 May 26;379(9830):1967-74
22520264
Spine (Phila Pa 1976). 2012 Nov 15;37(24):E1504-10
22926278
Spine (Phila Pa 1976). 2013 Apr 15;38(8):665-70
23060057
Bone Joint J. 2013 Jan;95-B(1):75-80
23307677
Eur Spine J. 2014 Apr;23 Suppl 1:S61-5
24413746
Spine (Phila Pa 1976). 2014 Sep 15;39(20):1707-13
24983931
Orthop Traumatol Surg Res. 2014 Sep;100(5):469-74
25128440
J Bone Joint Surg Am. 2014 Aug 20;96(16):1359-67
25143496
Appl Health Econ Health Policy. 2014 Dec;12(6):587-99
25172432
Eur Spine J. 2015 Jul;24(7):1457-61
25433541
Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S109-18
25623270
Pediatrics. 2015 Jul;136(1):e1-12
26055844
Spine (Phila Pa 1976). 2015 Dec;40(23):1851-6
26230537
Spine Deform. 2015 Mar;3(2):105-106
27927299
Spine Deform. 2014 Nov;2(6):493-497
27927412
Spine Deform. 2015 May;3(3):246-252
27927466
Clin Orthop Relat Res. 1984 May;(185):35-45
6705397
JAMA. 1996 Oct 16;276(15):1253-8
8849754