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.
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 $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 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.