Costs and Effectiveness of Scoliosis Screening

Abstract

Summary The continuing debate over the need for public health screening of schoolchildren for scoliosis centres on the efficacy of bracing compared to observation only. The objective of this study was to evaluate the costs and effectiveness of public health screening for idicpathic scoliosis. A retrospective analysis was conducted on 175,000 seventh grade (11–12 years old) schoolchildren in Oakland County, Michigan (1978/79 to 1990/91 school years inclusive). The analysis included the numbers of children screened and the proportions referred to doctors for evaluation, braced, and referred for surgery. Costs were determined for each step in the process. National and regional surveys were used to determine the costs associated with physicians, orthotists, hospitals, surgeons, administration, and false positive referrals involved in both conservative and surgical treatments. Screening approximately 12,000 + children per year in the Oakland County Programme costs $93,839 ($7.39 per child). This cost includes the cost of false positives. The costs per case for bracing and surgery were $4,748 and $35,510 respectively. Bracing was effective in reducing the need for surgery by 81 %. When these statistics are extrapolated to the entire United States, an equivalent screening programme would cost $90.9 million annually. Treating scoliosis without screening is estimated to cost $95.4 million annually in direct costs. This estimate does not include loss of income, welfare, social programmes and other direct or indirect medical costs that may occur with surgical intervention. Our results support the efficacy and cost effectiveness of public health screening for scoliosis.