Predicting the health economic performance of new non-fusion surgery in adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis (AIS) can lead to pain, impaired spinal function, and socio-psychological problems. Conventional surgical treatment of severe forms of AIS fuses the vertebrae, thereby restricting spinal function and growth of the adolescents. Non-fusion surgical treatment (NFS) is being proposed to prevent these drawbacks. To support the further development of NFS, this study aims to predict the health economic performance of the new NFS treatment and compare it with standard AIS treatment. A decision tree was constructed to compare NFS with bracing, possibly followed by posterior fusion surgery. The outcome measures were quality of life, complications, and costs. The Analytic Hierarchy Process (AHP), a technique for multi-criteria decision analysis, supported an expert panel of biomedical engineers and orthopaedic surgeons to predict the missing NFS performance data in the decision tree. The decision tree analysis showed that NFS is the preferred form of treatment in patients prone to disease progression. The advantages are its positive effect on spinal function and the self-esteem of the patient. Future clinical acceptance of NFS can be supported by reduced costs and an optimization of the prediction of progression. As more clinical evidence becomes available over time, these data can be added to the health economic model. (C) 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:14531458, 2012