title: Economic evaluation of strategies to reduce sudden cardiac death in young athletes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: National Institute of Mental Health, 6001 Executive Blvd, Room 8225 MSC 9669, Bethesda, MD 20892, USA. schoenbaumm@mail.nih.gov
authors: Michael
authors: M
authors: Schoenbaum
authors: Peter
authors: P
authors: Denchev
authors: Benedetto
authors: B
authors: Vitiello
authors: Jonathan R
authors: JR
authors: Kaltman
mesh_terms: D000293:Adolescent; D056352:Athletes; D016022:Case-Control Studies; D002648:Child; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D003661:Decision Support Techniques; D004562:Electrocardiography / Q000191:economics*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008487:Medical History Taking; D061213:Mortality, Premature; D010808:Physical Examination / Q000191:economics; D019057:Quality-Adjusted Life Years; D012017:Referral and Consultation / Q000191:economics; D014481:United States