{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:08:36Z","timestamp":1780096116467,"version":"3.54.0"},"reference-count":58,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>Neuromuscular 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We performed a cost-effectiveness analysis. Our decision analytic model included patients aged 5 to 20 years with NMS and a Cobb angle \u226550\u00b0, 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>We 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\u2009400 per patient. Under base-case assumptions, PSF costs $50\u2009100 per QALY gained. Our findings were sensitive to quality of life (QoL) and life expectancy, with PSF favored if it significantly increased QoL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>In 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/hpeds.2019-0153","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T14:15:12Z","timestamp":1583158512000},"page":"257-265","source":"Crossref","is-referenced-by-count":12,"title":["Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis"],"prefix":"10.1542","volume":"10","author":[{"given":"Jody L.","family":"Lin","sequence":"first","affiliation":[{"name":"Divisions of Pediatric Hospital Medicine and"},{"name":"Clinical Excellence Research Center, Stanford University, Stanford, California;"},{"name":"Division of Inpatient Medicine, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Tawfik","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Medicine, Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ribhav","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Biomechanical Engineering, School of Engineering,"},{"name":"Divisions of Infectious Diseases and Geographic Medicine, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Imrie","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eran","family":"Bendavid","sequence":"additional","affiliation":[{"name":"Primary Care and Population Health, Departments of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas K.","family":"Owens","sequence":"additional","affiliation":[{"name":"VA Palo Alto 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