Economic Evaluation of Strategies to Reduce Sudden Cardiac Death in Young Athletes
- 1 August 2012
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 130 (2), e380-e389
- https://doi.org/10.1542/peds.2011-3241
Abstract
OBJECTIVE: There is controversy about appropriate methods to reduce sudden cardiac death (SCD) in young athletes, but there is limited evidence on costs or consequences of alternative strategies. The objective of this study was to evaluate the cost-effectiveness of adding electrocardiogram (ECG) screening to the currently standard practice of preparticipation history and physical examination (H&P) to reduce SCD. METHODS: Decision analysis modeling by using a societal perspective, with annual Markov cycles from age 14 until death. Three screening strategies were evaluated: (1) H&P, with cardiology referral if abnormal (current standard practice); (2) H&P, plus ECG after negative H&P, and cardiology referral if either is abnormal; and (3) ECG only, with cardiology referral if abnormal. Children identified with SCD-associated cardiac abnormalities were restricted from sports and received cardiac treatment. Main outcome measures were costs of screening and treatment, quality-adjusted life years (QALYs), and premature deaths averted. RESULTS: Relative to strategy 1, incremental cost-effectiveness is $68 800/QALY for strategy 2 and $37 700/QALY for strategy 3. Monte Carlo simulation revealed the chance of incremental cost-effectiveness compared with strategy 1 was 30% for strategy 2 and 66% for strategy 3 (assumed willingness to pay ≤$50 000/QALY). Compared with strategy 1, strategy 2 averted 131 additional SCDs at $900 000 per case, and strategy 3 averted 127 SCDs at $600 000 per case. CONCLUSIONS: Under a societal willingness to pay threshold of $50 000/QALY, adding ECGs to current preparticipation evaluations for athletes is not cost-effective, with costs driven largely by false-positive findings.Keywords
This publication has 44 references indexed in Scilit:
- Quality of Life in Pediatric Patients With Implantable Cardioverter DefibrillatorsThe American Journal of Cardiology, 2011
- Epidemiology and Outcomes From Out-of-Hospital Cardiac Arrest in ChildrenCirculation, 2009
- Sudden Deaths in Young Competitive AthletesCirculation, 2009
- Contemporary approaches to the identification of athletes at risk for sudden cardiac deathCurrent Opinion in Cardiology, 2008
- The preparticipation cardiovascular screening of competitive athletes: is it time to change the customary clinical practice?European Heart Journal, 2007
- Long QT Syndrome in Children in the Era of Implantable DefibrillatorsJournal of the American College of Cardiology, 2007
- Evidence that pharmacological strategies lack efficacy for the prevention of sudden death in hypertrophic cardiomyopathyHeart, 2007
- Cost‐Effectiveness of Implanted Defibrillators in Young People with Inherited Cardiac ArrhythmiasAnnals of Noninvasive Electrocardiology, 2005
- Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocolEuropean Heart Journal, 2005
- Willingness to Pay for a Quality-adjusted Life YearMedical Decision Making, 2000