Abstract
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. DESIGN: Decision-analysis, cost-effectiveness model. DATA SOURCES: Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data. TARGET POPULATION: Competitive athletes in high school and college aged 14 to 22 years. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease. OUTCOME MEASURE: Incremental health care cost per life-year gained. RESULTS OF BASE-CASE ANALYSIS: 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 OF SENSITIVITY ANALYSIS: Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening. LIMITATIONS: Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries. CONCLUSION: Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective. PRIMARY FUNDING SOURCE: Stanford Cardiovascular Institute and the Breetwor Foundation.