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Editorials |20 May 2014

Cost-Effectiveness of Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors

Richard M. Steingart, MD; Jennifer E. Liu, MD; Kevin C. Oeffinger, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, New York.

    Acknowledgment: The authors thank Jersey Chen, MD, from the Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, for his thoughtful comments on cost-effectiveness analyses.

    Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0823.

    Requests for Single Reprints: Richard M. Steingart, MD, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; e-mail, steingar@mskcc.org.

    Current Author Addresses: Drs. Steingart and Liu: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.

    Dr. Oeffinger: Memorial Sloan Kettering Breast and Imaging Center, 300 East 66th Street, New York, NY 10065.

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It has long been recognized that anthracycline chemotherapy can cause early- and late-onset congestive heart failure (CHF) and cardiomyopathy, which may progress to cardiac-specific death (1). Thus, children treated with anthracycline are monitored during and periodically after therapy. The Children's Oncology Group (COG) developed the Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (COG-LTFU) in 2003 (2). In brief, periodic lifetime screening is recommended, based on age at treatment, cumulative anthracycline dose, and whether the heart was irradiated. These recommendations have been widely adopted.
In this issue, 2 groups separately examined these recommendations and report on the cost-effectiveness (CE) of screening to detect asymptomatic left ventricular dysfunction (ALVD) and to reduce CHF risks in childhood cancer survivors who were exposed to anthracycline chemotherapy (3, 4).
Cost-effectiveness analysis is a method for evaluating health outcomes and resource costs for health interventions. A base case is established that incorporates data and methods that best represent the interventions and choices under consideration. Its central function is to show the relative value of alternative interventions for improving health. In this case, it represents “no screening” for ALVD in childhood cancer survivors versus the recommendations of the COG-LTFU guidelines, then varies the screening interval and other variables to determine the CE of different strategies (5). Such analysis should be used as a supplement to other considerations in health care delivery, including equity, “benefits many,” and community compassion. The perspective used in the CE analysis is of overarching...
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Steingart RM, Liu JE, Oeffinger KC. Cost-Effectiveness of Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors. Ann Intern Med. 2014;160:731–732. doi: 10.7326/M14-0823

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Published: Ann Intern Med. 2014;160(10):731-732.

DOI: 10.7326/M14-0823

5 Citations

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