15 research outputs found
Direct costs associated with the management of progressive early onset scoliosis : estimations based on gold standard technique or with magnetically controlled growing rods
Background
The main disadvantage of the surgical management of early onset scoliosis (EOS) using conventional growing rods is the need for iterative surgical procedures during childhood. The emergence of an innovative device using distraction-based magnetically controlled growing rods (MCGR) provides the opportunity to avoid such surgeries and therefore to improve the patient's quality of life.
Hypothesis
Despite the high cost of MCGR and considering its potential impact in reducing hospital stays, the use of MCGR could reduce medical resource consumption in a long-term view in comparison to traditional growing rod (TGR).
Materials and methods
A cost-simulation model was constructed to assess the incremental cost between the two strategies. The cost for each strategy was estimated based on probability of medical resource consumption determined from literature search as well as data from EOS patients treated in our centre. Some medical expenses were also estimated from expert interviews. The time horizon chosen was 4 years as from first surgical implantation. Costs were calculated in the perspective of the French sickness fund (using rates from year 2013) and were discounted by an annual rate of 4%. Sensitivity analyses were conducted to test model strength to various parameters.
Results
With a time horizon of 4 years, the estimated direct costs of TGR and MCGR strategies were 49,067 ⏠and 42,752 âŹ, respectively leading to an incremental costs of 6135 ⏠in favour of MCGR strategy. In the first case, costs were mainly represented by hospital stays expenses (83.9%) whereas in the other the cost of MCGR contributed to 59.5% of the total amount. In the univariate sensitivity analysis, the tariffs of hospital stays, the tariffs of the MCG, and the frequency of distraction surgeries were the parameters with the most important impact on incremental cost.
Discussion
MCGR is a recent and promising innovation in the management of severe EOS. Besides improving the quality of life, its use in the treatment of severe EOS is likely to be offset by lower costs of hospital stays.
Level of evidence (with study design)
Level IV, economic and decision analyses, retrospective study.
Keywords
Early onset scoliosis; Direct costs; Spinal growing rods; Magnetically controlled growing rod
CoĂ»ts directs de prise en charge des scolioses infantiles et juvĂ©niles sĂ©vĂšres : estimations en fonction de lâutilisation des tiges de croissance conventionnelles ou des tiges de croissance magnĂ©tiques
Contexte
LâinconvĂ©nient majeur de la prise en charge des scolioses graves de survenue prĂ©coce (SGP) par la technique sans fusion avec distraction chirurgicale (tige de croissance conventionnelle) est la nĂ©cessitĂ© de recourir Ă des chirurgies itĂ©ratives pendant lâenfance. La diffusion rĂ©cente des tiges de croissance magnĂ©tiques (TCM) offre la possibilitĂ© dâĂ©viter de telles chirurgies et par consĂ©quent, dâamĂ©liorer la qualitĂ© de vie des patients.
HypothĂšse
MalgrĂ© le coĂ»t Ă©levĂ© des TCM et considĂ©rant leur impact potentiel sur la diminution du nombre de sĂ©jours hospitaliers, lâutilisation de ces tiges est susceptible de rĂ©duire la consommation de ressources mĂ©dicales Ă long terme en comparaison des tiges de croissance conventionnelles (TCC).
Matériel et méthode
Un modĂšle dâĂ©valuation mĂ©dicoĂ©conomique a Ă©tĂ© construit afin dâĂ©valuer et comparer le coĂ»t des deux stratĂ©gies. Ce coĂ»t a Ă©tĂ© estimĂ© Ă partir des probabilitĂ©s de consommation de ressources mĂ©dicales tirĂ©es dâune analyse de la littĂ©rature ainsi que des donnĂ©es dâune cohorte de patients avec SGP traitĂ©s dans notre centre. Certaines ressources mĂ©dicales ont Ă©galement Ă©tĂ© estimĂ©es Ă dire dâexperts. Un horizon temporel de quatre ans Ă partir de la premiĂšre implantation chirurgicale a Ă©tĂ© retenu. Les coĂ»ts ont Ă©tĂ© Ă©valuĂ©s selon la perspective de lâassurance maladie française (en utilisant les tarifs de lâannĂ©e 2013) et ont Ă©tĂ© actualisĂ©s avec un taux annuel de 4 %. Des analyses de sensibilitĂ© ont Ă©tĂ© conduites sur les diffĂ©rents paramĂštres du modĂšle afin dâĂ©valuer sa robustesse.
RĂ©sultats
Sur un horizon temporel de quatre ans, les coĂ»ts directs estimĂ©s pour les stratĂ©gies TCC et TCM ont Ă©tĂ© de 49 067 euros et 42 752 euros respectivement, soit un diffĂ©rentiel de coĂ»t de â6135 euros en faveur de la stratĂ©gie TCM. Dans le premier cas, les coĂ»ts Ă©taient principalement reprĂ©sentĂ©s par les sĂ©jours hospitaliers (83,9 %), alors que dans la stratĂ©gie TCM, le coĂ»t de la tige a contribuĂ© pour 59,5 % du montant total. Lâanalyse de sensibilitĂ© univariĂ©e a permis dâidentifier les paramĂštres ayant la plus grande influence sur le diffĂ©rentiel de coĂ»t en particulier : le coĂ»t des sĂ©jours hospitaliers, le coĂ»t des TCM, et la frĂ©quence des distractions chirurgicales.
Discussion
La stratĂ©gie TCM est une technique rĂ©cente et prometteuse dans la prise en charge des SGP. En plus dâamĂ©liorer la qualitĂ© de vie des patients, son utilisation dans le traitement des SGP est susceptible dâĂȘtre associĂ©e Ă une moindre consommation de ressources mĂ©dicales.
Background: The main disadvantage of the surgical management of early onset scoliosis (EOS) using
conventional growing rods is the need for iterative surgical procedures during childhood. The emergence
of an innovative device using distraction-based magnetically controlled growing rods (MCGR) provides
the opportunity to avoid such surgeries and therefore to improve the patientâs quality of life.
Hypothesis: Despite the high cost of MCGR and considering its potential impact in reducing hospital
stays, the use of MCGR could reduce medical resource consumption in a long-term view in comparison
to traditional growing rod (TGR).
Materials and methods: A cost-simulation model was constructed to assess the incremental cost between
the two strategies. The cost for each strategy was estimated based on probability of medical resource
consumption determined from literature search as well as data from EOS patients treated in our centre.
Some medical expenses were also estimated from expertinterviews. The time horizon chosen was 4 years
as from first surgical implantation. Costs were calculated in the perspective of the French sickness fund
(using rates from year 2013) and were discounted by an annual rate of 4%. Sensitivity analyses were
conducted to test model strength to various parameters.
Results: With a time horizon of 4 years, the estimated direct costs of TGR and MCGR strategies were
49,067 D and 42,752 D, respectively leading to an incremental costs of 6135 D in favour of MCGR strategy.
In the first case, costs were mainly represented by hospital stays expenses (83.9%) whereas in the other
the cost of MCGR contributed to 59.5% ofthe total amount. In the univariate sensitivity analysis,the tariffs
of hospital stays, the tariffs of the MCG, and the frequency of distraction surgeries were the parameters
with the most important impact on incremental cost.
Discussion: MCGR is a recent and promising innovation in the management of severe EOS. Besides improving
the quality of life, its use in the treatment of severe EOS is likely to be offset by lower costs of hospital
stays
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