title: Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis.
abstract: OBJECTIVE
  Sudden cardiac death is a leading cause of mortality in psychiatric patients. Long QT (LQT) is common in this population and predisposes to Torsades-de-Pointes (TdP) and subsequent mortality.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of electrocardiographic screening to detect LQT in psychiatric inpatients.
  
  
  METHODS
  We built a decision analytic model based on a decision tree to evaluate the cost-effectiveness and utility of LQT screening from a health care perspective. LQT proportion parameters were derived from an in-hospital cross-sectional study. We performed experts' elicitation to estimate the risk of TdP, given extent of QT prolongation. A TdP reduction of 65% after LQT detection was based on positive drug dechallenge rate and through adequate treatment and electrolyte adjustments. The base-case model uncertainty was assessed with one-way and probabilistic sensitivity analyses. Finally, the TdP related mortality and TdP avoidance parameters were varied in a two-way sensitivity analysis to assess their effect on the Incremental Cost-Effectiveness Ratio (ICER).
  
  
  METHODS
  Costs, Quality Ajusted Life Year (QALY), ICER, and probability of cost effectiveness thresholds ($ 10,000, $25,000, and $50,000 per QALY).
  
  
  RESULTS
  In the base-case scenario, the numbers of patients needed to screen were 1128 and 2817 to avoid one TdP and one death, respectively. The ICER of systematic ECG screening was $8644 (95%CI, 3144-82 498) per QALY. The probability of cost-effectiveness was 96% at a willingness-to-pay of $50,000 for one QALY. In sensitivity analyses, results were sensitive to the case-fatality of TdP episodes and to the TdP reduction following the diagnosis of LQT.
  
  
  CONCLUSIONS
  In psychiatric hospitals, performing systematic ECG screening at admission help reduce the number of sudden cardiac deaths in a cost-effective fashion.
authors.affiliation: Department of Health and Community Medicine, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Poncet
authors.affiliation: Cardiology Division, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Baris
authors.initials: B
authors.lastname: Gencer
authors.affiliation: Department of Internal Medicine, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Blondon
authors.affiliation: Department of Psychiatry, University Hospitals and University of Geneva, 2 chemin du Petit-Bel-Air, 1225, Chêne-Bourg, Switzerland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gex-Fabry
authors.affiliation: Department of Health and Community Medicine, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.affiliation: Cardiology Division, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Dipen
authors.initials: D
authors.lastname: Shah
authors.affiliation: Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwartz
authors.affiliation: Department of Anesthesiology, Intensive Care, and Clinical Pharmacology, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Besson
authors.affiliation: Department of Anesthesiology, Intensive Care, and Clinical Pharmacology, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland; Medical Directorate, University Hospitals and University of Geneva, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland; Centre for Health Economics, University of York, Heslington,York, United Kingdom.
authors.forename: François R
authors.initials: FR
authors.lastname: Girardin
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D004562:Electrocardiography / Q000191:economics; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities; D006801:Humans; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011336:Probability; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D016171:Torsades de Pointes / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult