Document Detail


Cost-effectiveness of neonatal ECG screening for the long QT syndrome.
MedLine Citation:
PMID:  16840497     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: A significant number of preventable cardiac deaths in infancy and childhood are due to long QT syndrome (LQTS) and to unrecognized neonatal congenital heart diseases (CHDs). Both carry a serious risk for avoidable mortality and morbidity but effective treatments exist to prevent lethal arrhythmias or to allow early surgical correction before death or irreversible cardiac damage. As an electrocardiogram (ECG) allows recognition of LQTS and of some of the CHDs that have escaped medical diagnosis, and as LQTS also contributes to sudden infant death syndrome, we have analysed the cost-effectiveness of a nationwide programme of neonatal ECG screening. Our primary analysis focused on LQTS alone; a secondary analysis focused on the possibility of identifying some CHDs also. METHODS AND RESULTS: A decision analysis approach was used, building a decision tree for the strategies 'screening'-'no screening'. Markov processes were used to simulate the natural or clinical histories of the patients. To assess the impact of potential errors in the estimates of the model parameters, a Monte Carlo sensitivity analysis was performed by varying all baseline values by +/-30%. Incremental cost-effectiveness analysis for the primary analysis shows that with the screening programme, the cost per year of life saved is very low: 11,740 euro. The cost for saving one entire life of 70 years would be 820,000 euro. Even by varying model parameters by +/-30%, the cost per year of life saved remains between 7400 euro and 20,400 euro. These figures define 'highly cost-effective' screening programmes. The secondary analysis provides even more cost-effective results. CONCLUSION: A programme of neonatal ECG screening performed in a large European country is cost-effective. An ECG performed in the first month of life will allow the early identification of still asymptomatic infants with LQTS and also of infants with some correctable CHDs not recognized by routine neonatal examinations. Appropriate therapy will prevent unnecessary deaths in infants, children, and young adults.
Authors:
Silvana Quaglini; Carla Rognoni; Carla Spazzolini; Silvia G Priori; Savina Mannarino; Peter J Schwartz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-07-13
Journal Detail:
Title:  European heart journal     Volume:  27     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-18     Completed Date:  2007-03-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1824-32     Citation Subset:  IM    
Affiliation:
Department of Computer Science and Systems, University of Pavia, Italy.
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MeSH Terms
Descriptor/Qualifier:
Cohort Studies
Cost-Benefit Analysis
Death, Sudden, Cardiac / prevention & control
Decision Trees
Electrocardiography / economics*
Humans
Infant, Newborn
Long QT Syndrome / diagnosis*
Markov Chains
Neonatal Screening / economics*,  methods
Quality-Adjusted Life Years
Comments/Corrections
Comment In:
Eur Heart J. 2007 Jan;28(1):137; author reply137-9   [PMID:  17158522 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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