Authors Luhmann SJ, McAughey EM, Ackerman SJ, Bumpass DB, McCarthy RE
Received 3 October 2017
Accepted for publication 9 January 2018
Published 16 March 2018 Volume 2018:10 Pages 179—187
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 2
Editor who approved publication: Professor Giorgio Lorenzo Colombo
Scott J Luhmann,1–3 Eoin M McAughey,4 Stacey J Ackerman,5 David B Bumpass,6 Richard E McCarthy6
1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA; 2Department of Orthopaedic Surgery, St. Louis Shriners Hospital, St. Louis, MO, USA; 3Department of Orthopaedic Surgery, St. Louis Children’s Hospital, St. Louis, MO, USA; 4Covance Market Access Services Inc., London, UK; 5Covance Market Access Services Inc., San Diego, CA, USA; 6Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Purpose: Treating early-onset scoliosis (EOS) with traditional growing rods (TGR) is effective but requires periodic surgical lengthening, risking complications. Alternatives include magnetically controlled growing rods (MCGR) that lengthen noninvasively and the growth guidance system (GGS), which obviate the need for active, distractive lengthenings. Previous studies have reported promising clinical effectiveness for GGS; however the direct medical costs of GGS compared to TGR and MCGR have not yet been explored.
Methods: To estimate the cost of GGS compared with MCGR and TGR for EOS an economic model was developed from the perspective of a US integrated health care delivery system. Using dual-rod constructs, the model estimated the cumulative costs associated with initial implantation, rod lengthenings (TGR, MCGR), revisions due to device failure, surgical-site infections, device exchange, and final spinal fusion over a 6-year episode of care. Model parameters were from peer-reviewed, published literature. Medicare payments were used as a proxy for provider costs. Costs (2016 US$) were discounted 3% annually.
Results: Over a 6-year episode of care, GGS was associated with fewer invasive surgeries per patient than TGR (GGS: 3.4; TGR: 14.4) and lower cumulative costs than MCGR and TGR, saving $25,226 vs TGR. Sensitivity analyses showed that results were sensitive to changes in construct costs, rod breakage rates, months between lengthenings, and TGR lengthening setting of care.
Conclusion: Within the model, GGS resulted in fewer invasive surgeries and deep surgical site infections than TGR, and lower cumulative costs per patient than both MCGR and TGR, over a 6-year episode of care. The analysis did not account for family disruption, pain, psychological distress, or compromised health-related quality of life associated with invasive TGR lengthenings, nor for potential patient anxiety surrounding the frequent MCGR lengthenings. Further analyses focusing strictly on current generation technologies should be considered for future research.
Keywords: early-onset scoliosis, cost analysis, growth guidance system, magnetically controlled growing rod, traditional growing rod