title: Cost Analysis of Patients Referred for Inherited Heart Rhythm Disorder Evaluation.
abstract: Inherited heart rhythm disorders (IHRDs) are complex and uncommon arrhythmogenic conditions that can lead to sudden unexpected death in seemingly healthy individuals. Multidisciplinary programs can assist in the diagnostic testing of potentially affected individuals and their family members.
  
  
  
  Patients evaluated in a specialized adult and pediatric IHRD clinic between April 2013 and February 2015 were characterized. The total costs per evaluation and diagnosis were calculated. Patients were divided according to referral indication (primary referral or family member).
  
  
  
  A total of 618 patients were evaluated (age 36 ± 21 years; 52% male), of which 274 (44%) were primary referrals and 344 (56%) were family members referred for cascade screening. Overall, 47% had at least 1 follow-up visit. Patients had a median of 3 tests; primary referrals required more tests (4 vs 2; P < 0.01). The median cost per patient was $1340 CAD. Evaluation of the primary referrals was costlier than family members ($3096 vs $983; P < 0.01). A definite or probable diagnosis was determined in 464 patients (77%), with no difference according to patient type (P = 0.18). The total cost per diagnosis was $4021 in primary referrals compared with $1277 in family members (P < 0.01).
  
  
  
  Clinical evaluation of patients with suspected IHRD results in a high diagnostic yield and costs aligned with other complex disorders involving multidisciplinary clinics. Evaluation costs are expectedly higher in primary referrals compared with targeted family screening.
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Mikyla L
authors.initials: ML
authors.lastname: Janzen
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cheung
authors.affiliation: British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Shubhayan
authors.initials: S
authors.lastname: Sanatani
authors.affiliation: British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Taylor
authors.initials: T
authors.lastname: Cunningham
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Kerr
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Steinberg
authors.affiliation: British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sherwin
authors.affiliation: Department of Medical Genetics, University of British Columbia, Victoria, British Columbia, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Arbour
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marc W
authors.initials: MW
authors.lastname: Deyell
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.affiliation: Department of Medical Genetics, University of British Columbia, Victoria, British Columbia, Canada.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Lehman
authors.affiliation: Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Lorne J
authors.initials: LJ
authors.lastname: Gula
authors.affiliation: Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: akrahn@mail.ubc.ca.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000151:congenital / Q000175:diagnosis* / Q000191:economics; D001955:British Columbia; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D012017:Referral and Consultation / Q000191:economics*; D012189:Retrospective Studies