School-based screening for scoliosis: is it cost-effective?

INTRODUCTION School-based scoliosis screening was implemented in Singapore in 1981. The rationale for the programme was so that conservative treatment (bracing) can be initiated early to prevent progression of curves, avoid the complications of severe scoliosis and reduce the need for surgery. The evidence for, or against, scoliosis screening and regular follow-up remains controversial. To date, there has been no formal cost analysis of Singapore's screening programme. The aim of this paper was to examine if there are economic justifications to continue with school-based scoliosis screening. METHODS This cost-effectiveness analysis was done by comparing Singapore's existing school-based scoliosis screening and follow-up programme with the alternative of not having a programme. As the aim of the existing programme was to detect curves early, allowing bracing to be initiated and reducing the need for surgery, this analysis assumed that without the programme, students who otherwise would have received bracing and not needed surgery, would have required surgery instead. This retrospective analysis was based on School Health Service data obtained from screening 45,485 students in 1999 and 44,051 of this same cohort in 2001. Nett programme costs and health effects were computed, and a decision rule applied. RESULTS The nett cost of the current mass screening programme was negative, while the nett health effects, albeit mostly intangible, positive; which made the programme an economically valuable one. CONCLUSION Singapore's school-based scoliosis screening programme, which is implemented as part of a larger school screening and immunisation programme, is cost-effective. Cost-effectiveness may be further improved by targeting screening at high-risk groups, such as prepubertal females. More research is needed to quantify the positive health effects of scoliosis screening.