Based On The Cost-Effect Study Of Scoliosis Screening In Schools In Guangzhou

Research background and purposes:The prevalence of adolescent idiopathic scoliosis(AIS)is about 1-3%,which can affect physical and mental health in severe cases.Regular screening is often an effective means of early detection,diagnosis and treatment of diseases.Although scoliosis screening has been included in physical examination by the Ministry of Education in China,no cost-effectiveness evaluation of screening intervention has made in China,and there are still controversies about school scoliosis screening programs in the world.The purpose of this study is to investigate the outcome and cost-effectiveness of scoliosis screening in primary and secondary schools in Guangzhou with an interdisciplinary approach,so as to provide a scientific basis for government decision-making.Research methods:First,Treeage Pro 2011 software was used to analyze the outcome and cost of regular AIS screening for junior high school students in Guangzhou by establishing a decision tree model and adopting the least cost analysis method.In 2019-2020,a total of 5024 students from grade 9 in some middle schools in Guangzhou were selected as the screening group,while a total of 5037 students from grade 9 in some middle schools in Foshan were selected as the non-screening group.The status of diagnosis and treatment of scoliosis and the costs(direct and indirect costs)of various diagnosis and treatment methods(such as PSSE,bracing and surgery)in Guangzhou were reviewed.The model probability,cost and other parameters were set,and the minimum cost analysis was conducted between the screening group and the non-screening group to compare the outcome and cost of screening and non-screening environment for school scoliosis of junior middle school students.Then Treeage Pro 2011 software is used to establish Markov model and Monte Carlo simulation method is used to analyze the cost-effect of 6-year school screening from grade 4 to grade 9.A two-stage decision analysis was used to model the cost-effectiveness of school screening versus non-screening from age 10 to natural death.The first stage was from 10 years old to 18 years old,and the simulation period was 3 years.The second stage was adult stage,and the simulation duration was 55 years and the simulation cycle was 5 years.The transition probability of each node,cost,discount,quality adjusted life year(QALY)and other parameters of the model were obtained through literature and our study.Incremental cost-effectiveness ratio(ICER)was obtained through cost-effectiveness analysis.And the single factor sensitivity analysis is used to analyze the uncertainty of each cost and probability.Research results:The results of minimum cost analysis:(1)the cost per person in the screening group was 197.04 yuan(95% CI: 144.75251.49),and the cost per person in the non-screening group was 118.23 yuan(95% CI: 72.13162.52).Assuming that the outcome of scoliosis patients with Cobb angle above 40 ° found through screening and not through screening is the same,when the treatment of the non-screening group is 60% of that of the screening group,the incremental cost is 15.67 yuan(95% CI:-3.68,36.75),when the treatment rate of the non-screening group is 70%,the incremental cost is 1.12 yuan(95% CI:-20.49,29.76),and when the treatment rate of the non-screening group is 80%,The incremental cost was-12.09 yuan(95% CI:-43.54,21.77).(2)Single factor sensitivity analysis showed that the referral rate was the main factor causing uncertainty.Monte Carlo simulation method was adopted to analyze the results:(1)Markov simulation results showed that the cumulative cost and health effect of the scoliosis adolescent screening group(672.42 yuan,2.52794QALY)were higher than those of the non-screening group(347.77 yuan,2.52773QALY),and ICER was 1555278.10 yuan /QALY.The cost and effectiveness of adult scoliosis screening group were165.57 yuan and 5.19468 QALY,while the cost and effectiveness of non-screening group were 340.87 yuan and 5.19278 QALY,ICER was-92209.09 yuan /QALY.The total cost and effect were 837.99 yuan and 7.72262 QALY in the scoliosis screening group,688.64 yuan and 7.72051 QALY in the non-screening group,and 70781.99 yuan /QALY in ICER.(2)Single factor sensitivity analysis showed that surgical cost,exercise cost and indirect cost were the sensitive parameters of scoliosis adolescents.Surgical cost and surgical rate are two sensitive parameters in adult scoliosis.Conclusions:Scoliosis screening in Guangzhou junior high schools is not cost-saving.The Monte Carlo simulation method is used to simulate and analyze the 6-year school screening from grade 4 to grade 9 in Guangzhou,and the results of ICER show that school screening is cost-effective to some extent.