Cost of pediatric sudden death screening ‘outweighs benefits’
MedWire News: Researchers say that the cost of screening children for sudden cardiac death (SCD) outweighs its benefits.
"Although economic efficiency alone should not dictate medical practice, the finite nature of health care expenditure implies that spending on one priority restricts spending on other priorities," remark Laurel Leslie (Tufts Medical Center, Boston, Massachusetts, USA) and team in Circulation.
They built simulation models incorporating detailed prevalence, sensitivity and specificity, and treatment algorithms to determine the cost-effectiveness of targeted SCD screening.
They constructed clinical care algorithms for 8-year-old asymptomatic children who initiated stimulants for attention deficient hyperactivity disorder (ADHD) and 14-year-old children who participated in organized sports, as these are the two groups thought to be at highest risk for SCD.
All children presented with a positive electrocardiogram (ECG) finding suggestive of one of the three most common pediatric disorders causing SCD and identifiable by ECG: hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, and long QT syndrome.
The researchers used information from existing literature, Medicaid fees, and expert judgement to develop simulation model assumptions.
They estimated that screening for all three conditions simultaneously would reduce SCD risk by 3.6-7.5x105 life-years, with projected life expectancy increases of 0.8-1.6 days per screened individual.
The incremental cost-effectiveness of screening was US$ 91,000-204,000 (€ 71,280-159,781) per life-year. Compared with other interventions, which often save life-years at US$ 50,000-110,000 (€ 39,162-86,156) or even less, this is expensive, say the authors, suggesting that "finite public health resources might be better spent elsewhere."
In a related commentary, J Philip Saul (Medical University of South Carolina, Charleston, USA) and Samuel Gidding (DuPont Hospital for Children, Delaware, USA) say that Leslie et al have "filled a critical gap in the evidence for screening to prevent SCD in children and adolescents, particularly by demonstrating the high cost of currently proposed prevention strategies."
They add that in order to prevent a significant portion of SCD in the young, a discussion of the best age to screen, the health benefits of ADHD medication, and sports participation, and the potential role of effective treatments at the point of SCD events are required.
By Piriya Mahendra