Abstract 15001: Cost Effectiveness of ECG Screening for Long QT Syndrome among Infants with Severe to Profound Sensorineural Hearing Loss
Introduction. Previous studies have shown that universal ECG screening of infants or children for long QT syndrome (LQTS) is cost effective in Italy but not in the United States. Infants with congenital sensorineural hearing loss (SNHL) are at increased risk for LQTS.
Hypothesis. Universal ECG screening of infants with severe to profound SNHL for LQTS may be cost-effective in this high risk population.
Methods. We conducted ECG screening of infants and children (≤6 years old) with unilateral or bilateral, severe to profound sensorineural or mixed hearing loss in California. The prevalence of LQTS from the statewide screening was used to perform cost effectiveness analysis. We calculated the incremental cost effectiveness of ECG screening by simulating two scenarios: “screening” and “no screening”, for infants (< 1 year) with SNHL. The sensitivity and specificity of ECG screening, costs of treatment and clinical follow-up, and life-years gained (LYG) were taken into account. Baseline values were drawn from our data and existing literature. Sensitivity analyses were performed by Monte Carlo simulations and by varying baseline values by ±50%. The main outcomes were the point estimate and the range of the incremental cost effectiveness of ECG screening.
Results. Three of 523 subjects (0.57%) were found to have LQTS, with prolonged QTc and gene mutations known to cause LQTS. Thus, a prevalence rate of 1 LQTS patient per 174 infants and young children with severe-profound SNHL was used in the analysis. Compared to no screening, life expectancy increases by 15.9 days per infant with SNHL screened by ECG. The incremental cost-effectiveness ratio of ECG screening is $6,356 per LYG. Sensitivity analyses provide a range of 8.0 - 23.8 days gained per infant with SNHL screened by ECG and a range of incremental cost-effectiveness of $2,803 - $14,178 per LYG.
Conclusions. ECG screening of infants with severe to profound SNHL is cost-effective in the U.S. Most infants with congenital SNHL are diagnosed early by state newborn hearing screening programs. Early diagnosis of LQTS by ECG screening in these high risk infants will make possible use of effective treatments to prevent sudden death. ECG screening for LQTS should be performed when severe-profound SNHL is confirmed in infants.
- © 2012 by American Heart Association, Inc.