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Pediatrics. 2012 Aug;130(2):e380-9. doi: 10.1542/peds.2011-3241. Epub 2012 Jul 2.
There is controversy about appropriate methods to reduce sudden cardiac death (SCD) in young athletes, but there is limited evidence on costs or consequences of alternative strategies. The objective of this study was to evaluate the cost-effectiveness of adding electrocardiogram (ECG) screening to the currently standard practice of preparticipation history and physical examination (H&P) to reduce SCD.
Decision analysis modeling by using a societal perspective, with annual Markov cycles from age 14 until death. Three screening strategies were evaluated: (1) H&P, with cardiology referral if abnormal (current standard practice); (2) H&P, plus ECG after negative H&P, and cardiology referral if either is abnormal; and (3) ECG only, with cardiology referral if abnormal. Children identified with SCD-associated cardiac abnormalities were restricted from sports and received cardiac treatment. Main outcome measures were costs of screening and treatment, quality-adjusted life years (QALYs), and premature deaths averted.
Relative to strategy 1, incremental cost-effectiveness is $68800/QALY for strategy 2 and $37700/QALY for strategy 3. Monte Carlo simulation revealed the chance of incremental cost-effectiveness compared with strategy 1 was 30% for strategy 2 and 66% for strategy 3 (assumed willingness to pay ≤$50000/QALY). Compared with strategy 1, strategy 2 averted 131 additional SCDs at $900000 per case, and strategy 3 averted 127 SCDs at $600000 per case.
Under a societal willingness to pay threshold of $50000/QALY, adding ECGs to current preparticipation evaluations for athletes is not cost-effective, with costs driven largely by false-positive findings.
在年轻运动员中，减少心源性猝死（SCD）的适当方法存在争议，但替代策略的成本或后果的证据有限。本研究的目的是评估通过心电图（ECG）筛查来降低 SCD 的成本效益，这种筛查方法可作为目前参与前病史和体检（H&P）标准的附加方法。
采用社会视角的决策分析模型，每年进行马尔可夫循环，从 14 岁到死亡。评估了三种筛查策略：（1）H&P，如果异常则进行心脏病学转诊（目前的标准做法）；（2）H&P，H&P 后加做心电图，如果心电图异常或 H&P 异常则进行心脏病学转诊；（3）仅进行心电图筛查，如果异常则进行心脏病学转诊。患有与 SCD 相关的心脏异常的儿童被限制参加运动并接受心脏治疗。主要观察指标为筛查和治疗的成本、质量调整生命年（QALY）和避免的过早死亡。
与策略 1 相比，策略 2 的增量成本效益为 68800 美元/QALY，策略 3 的增量成本效益为 37700 美元/QALY。蒙特卡罗模拟显示，与策略 1 相比，策略 2 的增量成本效益为 30%，策略 3 的增量成本效益为 66%（假设支付意愿≤50000 美元/QALY）。与策略 1 相比，策略 2 额外避免了 131 例 SCD，每例成本为 900000 美元，策略 3 额外避免了 127 例 SCD，每例成本为 600000 美元。
在社会支付意愿阈值为 50000 美元/QALY 的情况下，将 ECG 添加到目前的运动员参与前评估中并不具有成本效益，成本主要由假阳性发现驱动。
