Matthew T. Wheeler, MD, PhD; Paul A. Heidenreich, MD, MS; Victor F. Froelicher, MD; Mark A. Hlatky, MD; Euan A. Ashley, MB ChB, DPhil
Grant Support: From the Breetwor Foundation and the Stanford Cardiovascular Institute. Dr. Wheeler was supported by a U.S. Public Health Service training grant (5HL 07034) from the National Heart, Lung, and Blood Institute, National Institutes of Health.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M08-2738.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Ashley (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Euan A. Ashley, MB ChB, DPhil, Division of Cardiovascular Medicine, Stanford University, 300 Pasteur Drive, Falk Cardiovascular Research Building, Stanford, CA 94305; e-mail, email@example.com.
Current Author Addresses: Drs. Wheeler and Ashley: Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Falk Cardiovascular Research Building, Stanford, CA 94305-5406.
Dr. Hlatky: Department of Health Research and Policy, Stanford University School of Medicine, Redwood Building, T150A, Stanford, CA 94305-5405.
Drs. Froelicher and Heidenreich: Veterans Affairs Palo Alto Healthcare System, 3801 Miranda Avenue, Palo Alto, CA 94304.
Author Contributions: Conception and design: M.T. Wheeler, P.A. Heidenreich, V.F. Froelicher, M.A. Hlatky, E.A. Ashley.
Analysis and interpretation of the data: M.T. Wheeler, P.A. Heidenreich, V.F. Froelicher, M.A. Hlatky, E.A. Ashley.
Drafting of the article: M.T. Wheeler, M.A. Hlatky.
Critical revision of the article for important intellectual content: M.T. Wheeler, P.A. Heidenreich, V.F. Froelicher, M.A. Hlatky, E.A. Ashley.
Final approval of the article: P.A. Heidenreich, V.F. Froelicher, M.A. Hlatky, E.A. Ashley.
Statistical expertise: M.T. Wheeler.
Collection and assembly of data: M.T. Wheeler.
Wheeler MT, Heidenreich PA, Froelicher VF, Hlatky MA, Ashley EA. Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes. Ann Intern Med. 2010;152:276-286. doi: 10.7326/0003-4819-152-5-201003020-00005
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Published: Ann Intern Med. 2010;152(5):276-286.
Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness.
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.
Decision-analysis, cost-effectiveness model.
Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data.
Competitive athletes in high school and college aged 14 to 22 years.
Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease.
Incremental health care cost per life-year gained.
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 $42Â 900 per life-year saved (95% CI, $21Â 200 to $71Â 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 $76Â 100 per life-year saved ($62Â 400 to $130Â 000).
Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening.
Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries.
Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective.
Stanford Cardiovascular Institute and the Breetwor Foundation.
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Cardiology, Healthcare Delivery and Policy, High Value Care, Rhythm Disorders and Devices.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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