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Abstract
Progression of adolescent idiopathic scoliosis can lead to severe deformity affecting physical and psychosocial health. School screening for scoliosis may detect those who could benefit from early treatment; however its use remains controversial. Objective: To examine the literature in terms of cost and cost-effectiveness for school screening for scoliosis and to synthesize current evidence. Methods: We analyzed and graded articles published between 1950 and 2010 that mentioned cost or cost-effectiveness for scoliosis screening. Costs were converted to 2010 US dollars to facilitate comparisons. We also calculated the number of expected surgeries and compared it with observed number of scoliosis surgeries. Results: From a total of 13 papers that studied costs of school screening for scoliosis, seven met our quality criteria. Three out of five studies that discussed cost-effectiveness contended that school screening was cost-effective. Screening costs ranged between $0.48 to $20.04 and total costs per child screened (including follow-up and treatment costs) ranged between $0.62 and $61.03. Variations are due to pay-scales in different countries, qualifications of screeners, type of screening, cut-offs to define scoliosis and costs of medical appointments. In three of four studies that included patient follow-up, there was a reduction in expected surgeries ranging between 23 - 51%. Conclusion: Future research should evaluate cost-effectiveness in two comparable communities: one that has a school screening program vs. one that does not have it. Cost reduction strategies include modification of the cut-off for referral; screening of only high risk populations; and training non-physician personnel to conduct the screening.
Keywords: Screening, scoliosis, cost, cost-effectiveness
Introduction
Adolescent idiopathic scoliosis, a deformity that consists of a lateral deviation and axial rotation of the spine, has a prevalence of 1-3% among children aged 10-16 years (1,2). Progression of the scoliosis curve particularly during the adolescent growth spurt can lead to severe deformity affecting both physical and psychosocial aspects of health. The use of braces to prevent curve progression during adolescence may avert the need for surgery (3). Thus, screening for scoliosis may be useful in order to detect those who may benefit from early treatment and prevent progression and the need for surgery.
School screening programs for scoliosis vary with respect to the personnel involved (doctors, nurses, lay-persons), ages of children screened (ranges between 6-13 years),...