Abstract 16268: Cost-Effectiveness Analysis for Prophylactic Electrophysiology Studies and Ablation in Asymptomatic Pediatric Wolff-Parkinson-White Syndrome
BACKGROUND Patients with asymptomatic Wolff-Parkinson-White syndrome (WPW) are increasingly diagnosed and referred for electrophysiology studies (EPS) and ablation. Our aim was to evaluate the cost-effectiveness of EPS for elimination of sudden cardiac death (SCD) risk in asymptomatic pediatric WPW patients.
METHODS All children 5-18 years of age with WPW and at most trivial congenital heart disease who underwent initial intracardiac EPS at Children's Hospital Boston from January 2004 - June 2010 were stratified into symptomatic and asymptomatic groups. Using a Markov model, we determined the incremental cost-effectiveness ratio (cost per discounted life-year saved) of EPS versus observation based on published WPW incidence and risks combined with center-specific data on EPS outcomes and costs in symptomatic and asymptomatic patients.
RESULTS Utilizing a high published estimate of SCD in WPW of 0.5%/year, the incremental cost-effectiveness ratio of EPS was $74,337 in asymptomatic WPW and $67,745 in symptomatic WPW. Assumed SCD incidence had the greatest impact on estimated cost-effectiveness and represented the most important source of uncertainty in our model. Using a low published estimate of SCD incidence (0.05%/year), the costs per discounted life-year saved soared to $737,323 and $671,936 in asymptomatic and symptomatic patients, respectively. Altering model assumptions such as proportion of patients undergoing exercise testing or ablation, did not improve cost-effectiveness.
CONCLUSIONS If a high risk of SCD is assumed, EPS and ablation of pediatric WPW has a cost-effectiveness ratio that exceeds $50,000/life-year, making it modestly expensive compared to other health interventions considered cost-effective in the United States. EPS and ablation are very expensive if lower SCD risk is assumed. Cost-effectiveness was insensitive to presence of symptoms. This model illustrates the importance of defining SCD risk and the relative influences of alternative disease treatment assumptions and practice-specific factors. It also highlights potential downstream implications of pediatric cardiac screening programs.
- © 2011 by American Heart Association, Inc.