{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:51:25Z","timestamp":1790704285353,"version":"4.1.0"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u201corganized school-based screening\u201d with \u201cno organized screening, relying on opportunistic detection.\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1801371","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T05:43:52Z","timestamp":1778564632000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Economic evaluation of school scoliosis screening in Gannan Tibetan autonomous prefecture, Gansu Province: a cost-utility analysis based on decision tree-Markov model"],"prefix":"10.3389","volume":"14","author":[{"given":"Shaobo","family":"Yang","sequence":"first","affiliation":[{"name":"School of Integrative Medicine, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Spinal Deformity Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiji","family":"Miao","sequence":"additional","affiliation":[{"name":"School of Public Health, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Spinal Deformity Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Spinal Deformity Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Spinal Deformity Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Integrative Medicine, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Dou","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine of Traditional Chinese Medicine, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenheng","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine of Traditional Chinese Medicine, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhe","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine of Traditional Chinese Medicine, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianjun","family":"Duan","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine of Traditional Chinese Medicine, Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueting","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Public Health, Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiantao","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Spinal Deformity Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunjun","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, People\u2019s Hospital of Yongjing County","place":["Linxia, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaole","family":"Zhu","sequence":"additional","affiliation":[{"name":"School of Public Health, Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1007\/s43390-024-00939-3","article-title":"Improving prediction of progression of idiopathic scoliosis based on curve size and skeletal maturity","volume":"12","author":"Neal","year":"2024","journal-title":"Spine 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