Stanford University, California 94305, USA.
Ann Intern Med. 2010 Mar 2;152(5):276-86. doi: 10.7326/0003-4819-152-5-201003020-00005.
Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness.
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.
Decision-analysis, cost-effectiveness model.
Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data.
Competitive athletes in high school and college aged 14 to 22 years.
Lifetime.
Societal.
Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease.
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 are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening.
Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries.
Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective.
Stanford Cardiovascular Institute and the Breetwor Foundation.
在年轻运动员的参赛前筛查中加入 12 导联心电图（ECG）存在争议，因为人们担心其成本效益。
评估与仅进行心血管重点病史和体检相比，ECG 加心血管重点病史和体检用于参赛前筛查的成本效益。
决策分析，成本效益模型。
已发表的流行病学和参赛前筛查数据、生命统计数据和其他公开可用数据。
年龄在 14 至 22 岁的高中和大学生竞技运动员。
终身。
社会。
不参加竞技体育活动和针对患有心脏病的运动员的特定疾病治疗。
每获得 1 个生命年的增量医疗保健成本。
在每 1000 名运动员中，ECG 增加了 2.06 个生命年，每 1 名运动员的总成本增加了 89 美元，与仅进行心血管重点病史和体检相比，每获得 1 个生命年的成本效益比为 42900 美元（95%CI，每获得 1 个生命年的成本效益比为 21200 美元至 71300 美元）。与不筛查相比，ECG 加心血管重点病史和体检可使每 1000 名筛查运动员多获得 2.6 个生命年，每 1 名运动员的成本为 199 美元，每获得 1 个生命年的成本效益比为 76100 美元（62400 美元至 130000 美元）。
结果对与不参与相关的相对风险降低和初始筛查的成本敏感。
有效性数据来自 1 项主要的欧洲研究。各国猝死的原因模式可能不同。
对年轻运动员进行 12 导联心电图加心血管重点病史和体检筛查可能具有成本效益。
斯坦福心血管研究所和布雷特沃基金会。
