Abstract 11404: Electrocardiographic Screening for the Prevention of Sudden Cardiac Death in Youth: Cost-Effectiveness Hinges on the Identification and Treatment of the at Risk Population
Background: In the United States, the incidence of sudden cardiac death in youth is 0.6-8.0 per 100,000. Many of these deaths occur in asymptomatic children with previously undiagnosed conditions. In the US, two of the most common identifiable causes of sudden cardiac death in youth are hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQTS). Electrocardiograms (ECGs) can identify at risk children, but there is much debate and limited evidence on the cost-effectiveness of ECG screening.
Hypothesis: ECG screening is cost-effective in children in the US population.
Methods: The cost-effectiveness of screening with history and physical (H & P) plus ECG was compared to the current US standard, H & P alone, for the detection and subsequent treatment of HCM and LQTS. A theoretical cohort of healthy 12-year-olds was modeled, using a Markov model with a 70-year time horizon, from a payer's perspective. Extensive univariate and probabilistic sensitivity analyses were performed on all input variables.
Results: The incremental cost-effectiveness ratio (ICER) of screening H & P plus ECG compared to H & P alone was $46,130 / life year saved (LYS). In univariate sensitivity analyses the model was insensitive to uncertainty around almost all inputs except to the effect of identification and treatment of undiagnosed patients with low risk HCM (Range: $16,911/LYS to $398,905/LYS). The ICER was lower than the putative ICER thresholds of $50,000/LYS 45.4% of the time and $100,000/LYS 65.9% of the time in probabilistic sensitivity analysis (Figure 1).
Conclusions: Screening ECGs are moderately cost-effective for the prevention of sudden cardiac death. The crux of this debate lies in the ability to identify and effectively treat low risk individuals with HCM.
- © 2011 by American Heart Association, Inc.