Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes.
BACKGROUND
Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness.


OBJECTIVE
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.


METHODS
Decision-analysis, cost-effectiveness model.


METHODS
Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data.


METHODS
Competitive athletes in high school and college aged 14 to 22 years.


METHODS
Lifetime.


CONCLUSIONS
Societal.


METHODS
Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease.


METHODS
Incremental health care cost per life-year gained.


RESULTS
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
Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening.


CONCLUSIONS
Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries.


CONCLUSIONS
Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective.


BACKGROUND
Stanford Cardiovascular Institute and the Breetwor Foundation.
Wheeler
Matthew T
MT
Stanford University, California 94305, USA.
Heidenreich
Paul A
PA
Froelicher
Victor F
VF
Hlatky
Mark A
MA
Ashley
Euan A
EA
D000293:Adolescent; D000328:Adult; D056352:Athletes; D002318:Cardiovascular Diseases / Q000175:diagnosis; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D003661:Decision Support Techniques; D004562:Electrocardiography / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D010808:Physical Examination / Q000191:economics; D015995:Prevalence; D012680:Sensitivity and Specificity; D013334:Students; D055815:Young Adult