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Costs of School Scoliosis Screening: A Large, Population-Based Study

Lee, C. F., PhD*; Fong, Daniel Y. T., PhD*; Cheung, Kenneth M. C., MD; Cheng, Jack C. Y., MD; Ng, Bobby K. W., MD§; Lam, T. P., MD; Mak, K. H., MSc PH; Yip, Paul S. F., PhD; Luk, Keith D. K., MCh

doi: 10.1097/BRS.0b013e3181cbcc10
Health Services Research

Study Design. This was a population-based retrospective study.

Objective. To fully estimate the costs of the Hong Kong scoliosis screening program through a large, population-based study.

Summary of Background Data. School screening for scoliosis has often been criticized for having high costs. In fact, the screening cost that has reported varied widely, from less than 1 to more than 30 US dollars (USD) per child screened. This variation is mainly due to the incomplete inclusion of cost items.

Methods. We examined the screening and medical histories of a cohort of 115,190 screened students who were in Grade 5 in 1995/96 or 1996/97. The average costs spent on screening, diagnosing, following, and treating this cohort of students were calculated.

Results. The total expenses in the screening centers increased steadily from USD 380,930 in 1995/96 to USD 2,417,824 in 2005/06. Based on the 115,190 students who were followed up until they were 19 years old or they left school, the costs of screening and diagnosing 1 student during adolescence were USD 17.94 and USD 2.08, respectively. Of the 1311 referrals who attended the specialist hospitals for diagnosis, 264 and 39 had been braced and operated on, respectively. The medical care cost averaged USD 34.61 per student screened. The cost of finding 1 student with a curvature ≥20° and 1 treated case were USD 4475.67 and USD 20,768.29 respectively.

Conclusion. This was the largest study that has evaluated school scoliosis screening on students who were followed during their adolescence and accounted for all relevant costs. The cost per student screened in the scoliosis screening program in Hong Kong was comparable to that in Rochester, which had a similar protocol and was evaluated in a similar manner. The estimated costs can help the policy makers when they allocate healthcare resources.

The cost of the scoliosis screening program in Hong Kong was estimated by sufficiently following all screened students and accounting all relevant costs. With the additional use of moiré topography, the cost per student screened was comparable to that of the only study which was evaluated in a similar manner.

From the Departments of *Nursing Studies and †Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; ‡Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong SAR, China; §Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China; ¶Department of Health, Hong Kong SAR, China; and ∥Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.

Acknowledgment date: June 15, 2009. First revision date: September 22, 2009. Second revision date: October 27, 2009. Acceptance date: October 28, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by the Central Policy Unit of the Government of the Hong Kong Special Administrative Region and the Research Grants Council of the Hong Kong Special Administrative Region, China (Project number: HKU 7006-PPR-20051).

Address correspondence and reprint requests to Keith D. K. Luk, MPhil, Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial block, Queen Mary Hospital, Pokfulam, Hong Kong; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.