Abstract 15543: Cost-Benefit Analysis of Pre-Participation Screening: How Much is an Athlete's Life?
Background: The Italian preparticipation screening (PPS) by history, physical examination and 12-lead ECG has proven to identify young competitive athletes (YCAs) with at risk-heart diseases (such as hypertrophic and arrhythmogenic right ventricular cardiomyopathy) and to prevent sudden cardiovascular death (SCD) during sports. YCAs identified and disqualified because of such cardiomyopathies have been reported to have an excellent long-term outcome with nearly normal life expectancy.
Methods: We performed a cost-benefit analysis of the Italian PPS program for prevention of SCD in YCAs, based on the estimated mortality rates in the Veneto region of Italy over a 26 year-period, before (1979-1982) and after (1982-2004) screening implementation. In the setting of the Italian mass-screening, the cost of PPS is 30 € per each athlete.
Results: Mortality rates were 4.0/100,000 athlete-years in the pre-screening period and 0.4/100,000 athlete-years in the late-screening period, resulting in an estimated mortality reduction of 89%. Accordingly, 36 lives are saved annually by screening 1,000,000 YCAs (40 theoretical SCDs in unscreened YCAs less 4 real SCDs in screened YCAs). The cost to initially screen 1,000,000 YCAs (at 30 € each) is 30,000,000 € and the estimated cost to further evaluate those with positives findings (∼10% according to Italian data), mostly by echocardiography, is ∼6,000,000 €. Since the estimated total cost of screening (initial cost plus further evaluation cost) is 36,000,000 €, the estimated cost for one saved life is ∼1,000,000 € (36,000,000 € divided by 36 saved lives). Whether one assumes that former YCAs saved from SCDs because of disqualification from competitive sports will live an additional 20 years, the cost per year of life saved (YLS) is estimated at ∼50,000 € (1,000,000 € divided by 20 years); the estimated cost for additional 30 years will be ∼33,000 € per YLS.
Conclusions: The low cost of PPS in the setting of a population based program, the good PPS efficacy and specificity, and the expected large amount of life-years saved in disqualified YCAs, favourably influences the cost-benefit analysis of the Italian PPS, with cost estimates per YLS at or below the threshold to consider a health intervention as cost-effective.
- © 2011 by American Heart Association, Inc.