文献类型：期刊文献

英文题名：Economic evaluation of school scoliosis screening in Gannan Tibetan autonomous prefecture, Gansu Province: a cost-utility analysis based on decision tree-Markov model

作者：Yang, Shaobo[1];Wang, Juan[2];Miao, Peiji[3];Zhang, Chen[2];Huang, Jin[2];Yuan, Xiaoyun[2];Zhang, Yanxiang[1];Dou, Xiaohui[4];Zhang, Zhenheng[4];Liu, Zhe[4];Duan, Jianjun[4];Xu, Xueting[5];Wen, Jiantao[2];Cui, Shunjun[6];Zhu, Xiaole[5]

第一作者：Yang, Shaobo

通信作者：Wen, JT[1];Zhu, XL[2];Cui, SJ[3]

机构：[1]Gansu Univ Chinese Med, Sch Integrat Med, Lanzhou, Gansu, Peoples R China;[2]Gansu Prov Hosp Tradit Chinese Med, Dept Spinal Deform Surg, Lanzhou, Gansu, Peoples R China;[3]Gansu Univ Chinese Med, Sch Publ Hlth, Lanzhou, Gansu, Peoples R China;[4]Gansu Univ Chinese Med, Sch Clin Med Tradit Chinese Med, Lanzhou, Gansu, Peoples R China;[5]Soochow Univ, Sch Publ Hlth, Suzhou, Jiangsu, Peoples R China;[6]Peoples Hosp Yongjing Cty, Dept Orthoped, Linxia, Gansu, Peoples R China

第一机构：甘肃中医药大学

通信机构：[1]corresponding author), Gansu Prov Hosp Tradit Chinese Med, Dept Spinal Deform Surg, Lanzhou, Gansu, Peoples R China;[2]corresponding author), Soochow Univ, Sch Publ Hlth, Suzhou, Jiangsu, Peoples R China;[3]corresponding author), Peoples Hosp Yongjing Cty, Dept Orthoped, Linxia, Gansu, Peoples R China.

年份：2026

卷号：14

外文期刊名：FRONTIERS IN PUBLIC HEALTH

收录：;Scopus(收录号：2-s2.0-105040633300);WOS:【SSCI(收录号:WOS:001773693500001)，SCI-EXPANDED(收录号:WOS:001773693500001)】；

基金：The author(s) declared that financial support was received for this work and/or its publication. This work was supported by the Gansu Provincial Science and Technology Program (Key Joint Research Fund; Approval No. 25JRRA1220), the Gansu Provincial Science and Technology Program (General Joint Research Fund; Approval No. 25JRRA1224), the Gansu Provincial Science and Technology Program (Major Joint Research Fund; Approval No. 23JRRA1529), the Gansu Provincial Health and Wellness Industry Technological Innovation Major Project (Approval No. GSWSQNPY2024-03), the Gansu Provincial Talent Program (2024), and the Gansu Provincial Disease Prevention and Control Research Projects (Approval Nos. GSJKKY2025-08 and GSJKKY2025-46).

语种：英文

外文关键词：adolescent idiopathic scoliosis; cost-utility; Markov model; school-based screening; sensitivity analysis

摘要：Objective This study evaluates the cost-utility of school-based scoliosis screening for adolescents in resource-limited settings to inform regional school health and disease control policies.Methods We performed a model-based cost-utility analysis using real-world data from a screening program in Gannan Tibetan Autonomous Prefecture, Gansu Province. A decision tree linked to a Markov cohort model compared "organized school-based screening" with "no organized screening, relying on opportunistic detection." The model simulated a cohort of in-school adolescents until skeletal maturity over a 4-year baseline horizon, using 3-month Markov cycles. Health states were stratified by adolescent idiopathic scoliosis severity: mild, moderate (with or without bracing), severe (awaiting surgery), and post-operative stable. Adopting a healthcare system perspective, we estimated costs and quality-adjusted life years (QALYs), applying a 5% annual discount rate. Parameter uncertainty was assessed via deterministic and probabilistic sensitivity analyses.Results In the base-case analysis, the screening strategy dominated the opportunistic detection strategy, yielding a lower discounted per-person cost and a minimal discounted QALY gain of 0.000005. The incremental net monetary benefit was 58.33 CNY per person at a willingness-to-pay threshold of 52,825 CNY/QALY. Probabilistic sensitivity analysis showed most iterations in the cost-saving quadrant of the cost-utility plane, with incremental QALYs near zero, confirming the strategy's robust cost-saving potential across parameter uncertainties. The results were most sensitive to the assumed proportion of undiagnosed cases without screening, followed by surgical costs and disease progression probability. Scenario analysis indicated a more pronounced cost-saving advantage in regions with weaker routine diagnostic capacity.Conclusion From a healthcare system perspective, school-based adolescent scoliosis screening in resource-limited settings can be cost-saving during adolescence. The primary economic benefit arises from reducing progression to severe disease and avoiding high-cost surgeries. The limited modeled QALY gain likely reflects the short analytical horizon, which inadequately captures potential long-term quality-of-life benefits related to body image, mental health, and functional outcomes in adulthood.