Longitudinal comparison of direct medical cost, radiological and health-related quality of life treatment outcomes between traditional growing rods and magnetically controlled growing rods from preoperative to maturity.

BACKGROUND: Magnetically controlled growing rods (MCGR) have replaced traditional growing rods (TGR) in the past decade, however, a comparison of their direct costs and treatment outcomes based on real longitudinal data is lacking. This study aims to compare the direct cost and treatment outcomes between TGR and MCGR, whilst incorporating complications, reoperations and changes in health-related quality of life (HRQoL) throughout the entire treatment course. METHODS: Patients with early onset scoliosis (EOS) who underwent initial growing rod surgery between 2003 and 2016 at a tertiary scoliosis clinic were studied with longitudinal data. Accumulated direct medical costs were calculated based on the unit cost of surgeries of each TGR and MCGR, costs incurred for any rod exchange or remedial surgery for post-operative complication. Treatment outcomes were evaluated via: Patient's HRQoL using SRS-22r questionnaire, and radiological parameters (including major curve correction, spine length gains, spinal balance) throughout the treatment until maturity. RESULTS: A total of 27 EOS patients (16 MCGR, 11 TGR) were studied. Total direct cost of index surgery for MCGR was HKD$223,108 versus lower cost of HKD$135,184 for TGR (p < 0.001). At 2-3 years post-index surgery, accumulative total direct medical cost of MCGR and TGR became most comparable (TGR:MCGR ratio = 1.010) and had reached neutrality between the two groups since. Radiological parameters had no intergroup differences at maturity. For HRQoL, TGR group had shown the trend of less pain (domain score mean difference: 0.53, p = 0.024) post-index surgery and better self-appearance (domain score mean difference: 1.08, p = 0.017) before fusion. Higher satisfaction with treatment (domain score mean difference: 0.76, p = 0.029) was demonstrated by TGR patients at fusion/maturity. MCGR had negative (rs = -0.693) versus TGR's positive (rs = 0.989) correlations (p < 0.05) of cost and SRS-22r total scores at 2-3 years post-index surgery. CONCLUSIONS: From index surgery to maturity, TGR demonstrated better satisfaction with treatment by patients and comparable overall HRQoL with MCGR during the treatment course, as MCGR did not show apparent benefit despite less surgeries and cost neutrality between the two groups at 2-3 years post-index surgery.

Factors associated with the acceptance of mass drug administration for the elimination of lymphatic filariasis in Agusan del Sur, Philippines.

BACKGROUND: Mass drug administration (MDA) has been one of the strategies endorsed by the World Health Assembly for lymphatic filariasis (LF) elimination. Many factors, however, affect the acceptability of the MDA in the Philippines with acceptability defined as the ingestion of drugs -diethylcarbamazine and albendazole during MDA. These drugs were mainly distributed in fixed sites and mopping up activities were conducted through house-to-house visits to increase treatment coverage. The aim of conducting the study was to determine the MDA acceptance rate among a population endemic for LF, and the factors associated with MDA acceptance. METHODS: In April 2005, a stratified cluster survey involving 437 respondents aged 18 years old and above in Agusan del Sur, Philippines was conducted. Key informant interviews and focused group discussions were performed among community leaders and health service providers. Descriptive statistics and coverage estimates were calculated with appropriate sampling weights applied to all analyses. Factors assessed for association with receipt of antifilarial drugs and MDA acceptance were respondents' socio-demographic characteristics, knowledge, attitudes, beliefs and perceptions on LF. Pearson chi-squared test was used to determine factors associated with MDA acceptance. RESULTS: Results showed that 63.3% of the sampled population received the antifilarial drugs; of these, 94.5% ingested the drugs, yielding an acceptance rate of 60%. Half of the sampled population received the drugs from a fixed site, while only 13% was mopped up. A majority of the sampled population were aware of LF and MDA. Knowledge on LF prevention, cause, treatment and diagnosis and adverse events was low to moderate. Knowledge on LF and perceived benefits of antifilarial drugs were found to be associated with MDA acceptance (p = 0.08). Health workers remain the front liners in the MDA implementation. Local government units were aware of LF and MDA, but support was insufficient. CONCLUSION: The proportion of the sampled population that received and ingested the antifilarial drugs was much lower than the reported coverage. The target coverage rate of 85% may be achieved with sufficient groundwork for MDA, buy-in from the local government, greater efforts exerted to increase the people's knowledge on LF and MDA and their understanding of perceived benefits of the drugs. These would contribute to the successful elimination of LF in the province.