Cost effectiveness of school screening for scoliosis: A systematic review (pp. 7-13)
Authors: Debbie Ehrmann Feldman, Marie Beauséjour, José Félix Sosa, Lise Goulet, Stefan Parent, Hubert Labelle, and the members of the Quebec Scoliosis Society and the Canadian Pediatric Spinal Deformities Study Group
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.