Adding electrocardiogram screening to standard medical practices to reduce the number of sudden cardiac deaths in young athletes is not a cost-effective option for pre-participation evaluations, according to study results.
While most current clinical guidelines recommend that children considering competitive sports be screened with a careful history and physical examination beforehand, some experts advocate the addition of electrocardiograms (ECGs) to the current standard of care.
“Critics of such a strategy cite lack of evidence of effectiveness and feasibility, implications for personnel requirements, cost considerations and the negative impact of false-positive screening results,” the researchers wrote in a recent study in Pediatrics.
Michael Schoenbaum, PhD, of the National Institute of Mental Health, and colleagues conducted a modeled cost-effectiveness analysis of the following three strategies to reduce the number of sudden cardiac deaths in young athletes:
Strategy 1: Careful history and physical examination; children with potential abnormalities would be referred for pediatric cardiology evaluation (standard care).
Strategy 2: Careful history and physical examination followed by ECG in children with a negative history and physical examination; children with abnormalities on either test would be referred for definitive cardiology evaluation.
Strategy 3: Cardiac risk screening based on ECG only; children would still receive a careful history and physical examination but would be referred for cardiology evaluation based solely on abnormal ECG results.
The researchers analyzed the data using a societal perspective, with outcomes measured with the Quality-Adjusted Life-Year (QALY) scale, assuming the societal willingness to pay for medical care was equal to or below $50,000 per QALY.
Compared with the first strategy (standard care), incremental cost-effectiveness is $68,800/QALY for the second strategy and $37,700/QALY for the third strategy. The second strategy had a 30% chance of incremental cost-effectiveness and the third strategy had a 66% chance of incremental cost-effectiveness compared with the first strategy. The second strategy averted 131 additional sudden cardiac deaths at $900,000 per case, and the third strategy averted 127 sudden cardiac deaths at $600,000 per case.
“Current evidence does not support adopting a policy of universal ECG screening of young athletes, in the sense that the outcomes of such a policy do not appear to warrant its costs,” Schoenbaum told Healio.com. “However, patients — or their parents — who have higher willingness to pay than we assume for society overall may reach different conclusions.”
Disclosure: Dr. Schoenbaum reports no relevant financial disclosures.