The True Cost of Late Presentation in Adolescent Idiopathic Scoliosis: A 5-Year Follow-up Study.

Abstract

Adolescent idiopathic scoliosis (AIS) is the most prevalent pediatric spinal condition. During growth, moderate scoliosis is treated with a brace to minimize the risk of progression to the surgical range. However, a minority of patients meet brace indications, with a greater number presenting late, already appropriate for surgery. This study determines the treatment cost differential between brace candidates and late-presenting patients within a public health care setting. This is a retrospective review of 373 consecutive AIS patients seen for initial consultation in 2014 and followed for 5 years, with a cost-analysis of the 166 patients that either met brace indications (n=63) or presented late (n=103). Patients meeting the Scoliosis Research Society's brace indications presented with a coronal curve magnitude between 25 and 40 degrees inclusive and were skeletally immature with a Risser ≤2. Late-presenting patients had coronal curve magnitudes of ≥50 degrees (n=73) or were presented with coronal curve magnitudes of >40 degrees and were skeletally immature with Risser ≤2 (n=30). Total treatment cost was estimated for 3 scenarios: (1) use of predetermined cut points for treatment prescription, (2) real-world approximation reflecting actual, nuanced clinical decision-making, and (3) the ideal situation, such that all late patients were instead seen as brace candidates. Each patient who was prescribed a brace and avoided progression to the surgical range saved $23,000 in treatment costs. Eliminating late presentation of AIS would save at least $2 to $3 million per year at a single institution. Significant cost savings can be found by optimizing the number of patients treated with a brace and minimizing the number of patients that present late as likely surgical candidates. This study provides financial impetus for early AIS detection, decreasing the number of avoidable surgeries. Scoliosis screening recommendations in primary care should be re-examined, alongside the development of educational tools, equipping primary care providers, and youth and their caregivers with appropriate knowledge on how to identify AIS. Level III-retrospective comparative study.