Brace compression for treatment of pectus carinatum: a rapid health technology assessment
Health technology assessment|
The Norwegian Institute of Public Health has conducted a rapid health technology assessment about brace compression for treatment of pectus carinatum, often referred to as “bird chest”.
The Norwegian Institute of Public Health has conducted a rapid health technology assessment about brace compression for treatment of pectus carinatum, often referred to as “bird chest”. The condition is characterized by anterior protrusion of the sternum and occurs in approximately 1 per 1,500 live births. Many patients with pectus carinatum experience a reduced quality of life and increased psychosocial stress.
Pectus carinatum is traditionally treated with open surgery, but this is only relevant for a minority of patients with serious defects. For most people with this condition, orthotic brace is the only treatment alternative, but this offer is currently limited to patients in the South-Eastern Norway Regional Health Authority and a small number of patients in the Western Norway Regional Health Authority. The professional environment is requesting a nationwide offer of orthotic brace treatment for this patient group.
Effectiveness and safety:
- We included two systematic reviews and three primary studies. The documentation consisted of observational studies without control groups. The results indicated that orthotic brace treatment can have positive effects on the correction of chest wall deformity in this patient group. However, the studies were heterogeneous, especially with regard to the use of type of orthotic brace and treatment procedure (including selection of patients, treatment regimens, reporting etc.) and had significant methodological limitations. It is therefore not possible to draw firm conclusions about the effect.
- No serious adverse events leading to hospitalization were reported in the studies. The proportion of patients who reported complications was in most studies between 10-17%.
- In an update search (01.23), we identified one HTA report and three new studies, yet the documentation and the patients largely overlapped with what we already had included after the first search. The results of these studies did not change our conclusions.
- The costs related to orthotic brace treatment are between NOK 37,900 - 43,500 per patient, compared to approximately NOK 200 000 related to surgical treatment. The brace treatment can be cost-saving when it replaces surgery. For patients who previously were not receiving any treatment, it will incur incremental costs.
- Based on clinical experience, the treatment effect is considered to be good. The experts have not experienced serious adverse events and believe that the treatment with orthotic brace involves less risk for the patients than with surgery. It is recommended that surgery should only be considered in patients who are not suitable for orthotic brace treatment.
- Selection of motivated and suitable patients is crucial for successful orthotic brace treatment, and the treatment most often starts between the ages of 14-16 years.
- A nationwide offer of orthotic brace treatment will probably lead to more patients wanting treatment.
It is not possible to draw firm conclusions about the effectiveness and safety of orthotic brace treatment of pectus carinatum based on the available documentation. According to clinical experience, the method is considered most likely to be a useful treatment for selected patients and may reduce psychosocial problems in some of the patients. In addition, the method entails less risk for the patient compared to surgery. The costs associated with orthotic brace treatment are estimated to be between NOK 37,900 - 43,500 per patient compared to approximately NOK 200 000 for surgical treatment. Since pectus carinatum is a relatively rare condition, we consider it unlikely that further research within this topic will occur in the next few years that will strengthen the documentation significantly.