A health economic evaluation of screening and treatment in patients with

adolescent idiopathic scoliosis

Estimating costs and resources

In estimating the costs of screening, bracing and surgery, the actual hospital costs,
administrative data and market prices were used to come up with the figure.

Screening

Screening for scoliosis was performed by community nurses and physical therapists once in
the 4,000 twelve-year old children in Norway, as part of their vaccine and physical examination
program from the period of autumn 2006 to spring 2008. Activities involved in screening and
follow-up of patients were identified, it was measured and the costs were estimated as shown
in Table 1.

Bracing and surgery

The estimated costs for bracing and surgery were based on data from the hospital
records. For bracing, the costs include : brace equipment, transportation, radiographic
and clinical examinations during the period of brace wear, 3 days of hospital, hotel
services for the child and one parent during the brace fitting, reimbursements costs for
wear and tear clothing and beddings from the National Insurance Scheme. For
surgery, the costs include :costs of implants, salaries of the staff, intensive care,
intermediate post-operative care, regular ward costs, costs of re-operations as shown
in Table 1.

Surgery is performed by two surgeons, Surgeons use either a hybrid construct with an
average of 5 pedicle screws, 8 hooks, 5 to 6 sub-laminar wires or an all pedicle screw
construct using 15 to 17 pedicle screws, for about 180 minutes. The surgeons are
assisted by one anesthesiologist, one anesthesiologist nurse, two scrub nurses working
on average of 300 minutes. The patient stays in the hospital for an average of 10 days
after the surgery and is required to do two follow-up consultations during the first post-
operative year. Additional costs for radiological examinations, out-patient follow-up
visits, transportation, costs of complications and re-operations during the first year were
included.

Hospital fees for children undergoing braced or surgically treated are subsidized by the
public universal healthcare system in Norway. Only cost per hour for different health
professionals were added to the bill(such as pension, insurance, sick-leave, training,
income tax). The salary and social costs for hospital staff were based on the salary at
the Oslo University. Hospital and the estimates of the overhead costs were based on
data from the Norwegian Central Bureau of Statistics. Salary and social costs of public
health nurses were based on data from the Norwegian Nurses organization, and local
community administrations.
Currency, price date and conversion

All prices and costs were converted from 2006 to 2012 NOK (Norwegian
kroner)(Currency of Norway) Converted by using an inflation rate of 3.21% per year
based on the yearly rate of change of one unit value within the Diagnosis-Related Group
(DRG)