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Review
. 2021 Dec 1;46(23):1653-1659.
doi: 10.1097/BRS.0000000000004189.

Cost-utility Analysis Comparing Bracing Versus Observation for Skeletally Immature Patients with Thoracic Scoliosis

Ijezie Ikwuezunma  1 , Kevin Wang, Adam Margalit, Paul Sponseller, Amit Jain
Affiliations
Review

Cost-utility Analysis Comparing Bracing Versus Observation for Skeletally Immature Patients with Thoracic Scoliosis

Ijezie Ikwuezunma et al. Spine (Phila Pa 1976). .

Abstract

Study design: Cost-utility analysis.

Objective: This study aimed to investigate the cost-utility of bracing versus observation in patients with thoracic scoliosis who would be indicated for bracing.

Summary of background data: There is high-quality evidence that bracing can prevent radiographic progression of spinal curvature in adolescent idiopathic scoliosis (AIS) patients with curves between 25° and 40° and Risser 0 to 2 skeletal maturity index. However, to our knowledge, the cost-utility of bracing in AIS has not been established.

Methods: A decision-analysis model comparing bracing versus observation was developed for a hypothetical 10-year old girl (Risser 0, Sanders 3) with a 35° main thoracic curve. We estimated the probability, cost, and quality-adjusted life years (QALY) for each node based on comprehensive review of the literature. Costs were adjusted for inflation based on Consumer Price Index and reported in terms of 2020 real dollars. Incremental net monetary benefit (INMB) was calculated based on a probabilistic sensitivity analysis using Monte Carlo simulations of 1000 hypothetical patients. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates.

Results: Our decision-analysis model revealed that bracing was the dominant treatment choice over observation at $50,000/QALY willingness to pay threshold. In simulation analysis of a hypothetical patient cohort, bracing was associated with lower net lifetime costs ($60,377 ± $5,340 with bracing vs. $85,279 ± $4543 with observation) and higher net lifetime QALYs (24.1 ± 2.0 with bracing vs. 23.9 ± 1.8 with observation). Bracing was associated with an INMB of $36,093 (95% confidence interval $18,894-$55,963) over observation over the patient's lifetime. The model was most sensitive to the impact of bracing versus observation on altering the probability of requiring surgery, either as an adolescent or an adult.

Conclusion: Cost-utility analysis supports scoliosis bracing as the preferred choice in management of appropriately indicated AIS patients with thoracic scoliosis.Level of Evidence: 5.

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Comment in

  • Point of View.
    Weinstein SL. Weinstein SL. Spine (Phila Pa 1976). 2021 Dec 1;46(23):1660. doi: 10.1097/BRS.0000000000004205. Spine (Phila Pa 1976). 2021. PMID: 34468437 No abstract available.

References

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    1. Karavidas N. Bracing in the treatment of adolescent idiopathic scoliosis: evidence to date. Adolesc Health Med Ther 2019; 10:153–172.
    1. Weinstein SL, Dolan LA, Wright JG, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013; 369:1512–1521.
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    1. Roach JW, Mehlman CT, Sanders JO. Does the outcome of adolescent idiopathic scoliosis surgery justify the rising cost of the procedures?”. J Pediatr Orthop 2011; 31: (1 suppl): S77–S80.

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