Adobor Raphael D, Joranger Paal, Steen Harald, Navrud Ståle, Brox Jens Ivar
Section for Spine Surgery, Department of Orthopedic Surgery, Oslo University Hospital-Rikshospitalet, Pb 4950, Nydalen, N-0424 Oslo, Norway.
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.
Scoliosis. 2014 Dec 6;9(1):21. doi: 10.1186/s13013-014-0021-8. eCollection 2014.
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.
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.
To compare estimated costs in screening and non-screening scenarios (reduced treatment rates of 90%, 80%, 70% of screening, and non-screening Norway 2012).
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.
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.
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.
青少年特发性脊柱侧弯可能会进展，并影响患者与健康相关的生活质量。研究表明，筛查在早期检测中有效，可实现支具治疗并降低手术率，还可能节省成本，但从卫生经济学角度来看仍存在争议。
基于模型的成本最小化分析，使用医院成本、行政数据和市场价格来估算筛查、支具治疗和手术治疗的成本。通过确定性和概率敏感性分析来描述不确定性。时间范围是从11岁首次筛查起的6年。
比较筛查和非筛查方案（治疗率降低90%、80%、70%的筛查以及2012年挪威非筛查情况）的估算成本。
数据基于初级卫生保健和医院护理环境中的筛查和治疗成本。参与者包括2012年在挪威接受筛查的4000名12岁儿童、在香港接受筛查的115190名儿童以及在挪威接受脊柱侧弯治疗的112名儿童。我们假设与健康相关的生活质量结果相同，仅比较筛查和非筛查环境中的相对成本。当非筛查方案相对于筛查更昂贵时，增量成本定义为正数。
每名儿童的筛查成本为8.4欧元（95%可信区间为6.6至10.6欧元），每名接受支具治疗的患者成本为10350欧元（8690至12180欧元），每名接受手术的儿童成本为45880欧元（39040至55400欧元）。治疗率为90%的非筛查方案中，每名儿童的增量成本为13.3欧元（1至27欧元），随着相对于支具治疗的手术率从40%增加到80%，增量成本从1.3欧元（-8至11欧元）增加到27.6欧元（14至44欧元）。对于治疗率为80%的非筛查方案，全部筛查时增量成本为5.5欧元（-6至18欧元），仅筛查女孩时增量成本为11.3欧元（2至22欧元）。对于挪威的非筛查方案，每名儿童的增量成本为-0.1欧元（-14至16欧元）。支具治疗和手术是主要的成本驱动因素，对不确定性的贡献最大。
根据本研究中应用的假设，仅对女孩进行筛查且能降低治疗率时，筛查可节省成本。在非筛查情况下手术成本占主导，而在筛查情况下支具治疗成本占主导。当筛查导致更高的支具治疗率和更低的手术率时，筛查的经济收益会增加。
