Evidence map›Paper›PMID 32079619›Full record

ArticleHospital pediatrics2020

Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis.

Jody L Lin, Daniel S Tawfik, Ribhav Gupta, Meghan Imrie, Eran Bendavid, Douglas K Owens

Open access · greenAbstract readComparative Study
In one paragraph

Article in Hospital pediatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.8field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 10 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

Jody L LinDivisions of Pediatric Hospital Medicine and jody.lin@hsc.utah.edu.
Daniel S TawfikPediatric Critical Care Medicine, Department of Pediatrics.
Ribhav GuptaDivision of Biomechanical Engineering, School of Engineering.
Meghan ImrieOrthopedic Surgery.
Eran BendavidPrimary Care and Population Health, Departments of Medicine and.
Douglas K OwensVA Palo Alto Health Care System, Palo Alto, California.
Orthopedic One · USPrimary Health Care · QAStanford University · USVA Palo Alto Health Care System · US

Funding

Stanford Center for Clinical & Translational Education and Research (Spectrum)UL1TR003142 · NCATS · STANFORD UNIVERSITY · PI O'HARA, RUTH M · 2019 to 2023
$45.0M
Spectrum Stanford Center for clinical and Translational Research and EducationUL1TR001085 · NCATS · STANFORD UNIVERSITY · PI CULLEN, MARK RICHARD, GREENBERG, HARRY BERNARD · 2013 to 2017
$37.1M
Institutional Career Development Core (KL2)KL2TR003143 · NCATS · STANFORD UNIVERSITY · PI ASCH, STEVEN M. · 2019 to 2023
$8.7M
Spectrum Stanford Center for clinical and Translational Research and EducationKL2TR001083 · NCATS · STANFORD UNIVERSITY · PI CULLEN, MARK RICHARD, GREENBERG, HARRY BERNARD · 2013 to 2017
$4.9M
NCATS NIH HHS KL2 TR001083NCATS NIH HHS KL2 TR003143NCATS NIH HHS UL1 TR001085NCATS NIH HHS UL1 TR003142
6 · The paper itself

Abstract

objectivesNeuromuscular scoliosis (NMS) can result in severe disability. Nonoperative management minimally slows scoliosis progression, but operative management with posterior spinal fusion (PSF) carries high risks of morbidity and mortality. In this study, we compare health and economic outcomes of PSF to nonoperative management for children with NMS to identify opportunities to improve care.

methodsWe performed a cost-effectiveness analysis. Our decision analytic model included patients aged 5 to 20 years with NMS and a Cobb angle ≥50°, with a base case of 15-year-old patients. We estimated costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness from published literature and conducted sensitivity analyses on all model inputs.

resultsWe estimated that PSF resulted in modestly decreased discounted life expectancy (10.8 years) but longer quality-adjusted life expectancy (4.84 QALYs) than nonoperative management (11.2 years; 3.21 QALYs). PSF costs $75 400 per patient. Under base-case assumptions, PSF costs $50 100 per QALY gained. Our findings were sensitive to quality of life (QoL) and life expectancy, with PSF favored if it significantly increased QoL.

conclusionsIn patients with NMS, whether PSF is cost-effective depends strongly on the degree to which QoL improved, with larger improvements when NMS is the primary cause of debility, but limited data on QoL and life expectancy preclude a definitive assessment. Improved patient-centered outcome assessments are essential to understanding the effectiveness of NMS treatment alternatives. Because the degree to which PSF influences QoL substantially impacts health outcomes and varies by patient, clinicians should consider shared decision-making during PSF-related consultations.

Indexed as

Cost-Benefit AnalysisQuality-Adjusted Life YearsQuality of LifeAdolescentChildChild, PreschoolConservative TreatmentDecision Support TechniquesFemaleHealth Care CostsHumansLife ExpectancyMaleModels, EconomicNeuromuscular DiseasesScoliosis

Identifiers

PMID32079619
PMCPMC7041549
OpenAlexW3009014544

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.