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Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death

FULLER, COLIN M.

Medicine & Science in Sports & Exercise: May 2000 - Volume 32 - Issue 5 - pp 887-890
CLINICAL SCIENCES: Clinically Relevant

FULLER, C. M. Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med. Sci. Sports Exerc., Vol. 32, No. 5, pp. 887–890, 2000. Sudden cardiac death of a high school athlete is an alarming tragedy. Three preparticipation screening methods have been recommended to reduce its occurrence: specific cardiovascular history and physical examination, 12-lead ECG, and two-dimensional (2D) echocardiography. This study analyzes the cost effectiveness of each of these methods. The cost to perform each test and to evaluate abnormal screening findings were approximated. The years of life gained through detection of athletes with potential causes of sudden cardiac death were estimated. Overall, the approximate costs per year of life saved for the preparticipation cardiovascular screening examinations are: specific cardiovascular history and physical examination, $84,000; 12-lead ECG, $44,000; and 2D echocardiography, $200,000. The 12-lead ECG is the most cost effective preparticipation cardiovascular modality of the three currently recommended methods. Similar cost effectiveness for history and physical examination or 2D echocardiography would require respectively a 2-fold increase in sensitivity or 4.5-fold decrease in cost.

Sudden cardiac death (SCD) in high school athletes (HSA) is an infrequent, tragic, and alarming event. In an effort to reduce its occurrence, most states, through the authority of legislation, have mandated preparticipation examinations (6). The thoroughness and quality of these examinations varies from state to state (8). The ability of the standard cardiovascular (CV) history and physical examination to detect HSA with the causes of SCD is acknowledged to be exceedingly low (12). A recent consensus statement from the American Heart Association (AHA) recommends a uniform specific cardiovascular history and physical examination every 2 yr (and revised recently to every 4 yr) by a certified health care professional during high school and college years (13). Others have recommended a 12-lead ECG once during the athlete’s high school career as the sole CV screening examination (7). Alternatively, two-dimensional (2D) echocardiography has been suggested as a sensitive and specific screening tool (5,18). This report compares the approximate cost effectiveness of each of these recommended CV screening modalities.

Sierra Nevada Cardiology Associates and Sierra Heart Institute, Reno, NV 89502

Submitted for publication June 1999.

Accepted for publication August 1999.

Address for correspondence: Colin M. Fuller, M.D., Sierra Nevada Cardiology Associates, 75 Pringle Way, Suite 401, Reno, NV 89502; E-mail: RFuller007@aol.com.

©2000The American College of Sports Medicine