Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes

Matthew T Wheeler, Paul A Heidenreich, Victor F Froelicher, Mark A Hlatky, Euan A Ashley
Annals of Internal Medicine 2010 March 2, 152 (5): 276-86

BACKGROUND: Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness.

OBJECTIVE: To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening.

DESIGN: Decision-analysis, cost-effectiveness model.

DATA SOURCES: Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data.

TARGET POPULATION: Competitive athletes in high school and college aged 14 to 22 years.



INTERVENTION: Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease.

OUTCOME MEASURE: Incremental health care cost per life-year gained.

RESULTS OF BASE-CASE ANALYSIS: Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000).

RESULTS OF SENSITIVITY ANALYSIS: Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening.

LIMITATIONS: Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries.

CONCLUSION: Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective.

PRIMARY FUNDING SOURCE: Stanford Cardiovascular Institute and the Breetwor Foundation.


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