Boston, MAŚ An article, published in Circulation by Laurel K. Leslie, MD, MPH from the Tufts Clinical and Translational Science Institute (CTSI) and colleagues from Tufts Medical Center and Floating Hospital for Children at Tufts Medical Center, has evaluated the lifesaving benefits and costs of screening programs for the prevention of sudden cardiac death (SCD) in children and adolescents. The authors found that screening can save lives, but that because it targets rare conditions and available tests have limited accuracy, screening for SCD is costly, compared to other life-saving measures.
Although rare, SCD often receives widespread attention because it is unexpected and can occur during childhood. Those factors have prompted many parents and policy makers to support screening programs. To help decision makers and the public understand whether more SCD screening is warranted, the authors, including collaborating clinical researchers from Children's Hospital Boston, compared the potential life saving benefits (measured in terms of life years saved) to program costs. They considered two groups thought to be at elevated risk: school-aged children taking stimulants, which are often used to treat Attention Deficit Hyperactivity Disorder (ADHD), and adolescents playing organized sports. The research team determined that each year of life saved would cost from $90,000 (to screen adolescents before they participate in sports) to $200,000 (to screen children before they take ADHD medications).
Although there is no hard and fast line separating worthwhile and expensive public health interventions, programs can be compared to get an idea of their value. For example, interventions that cost $90,000 to $200,000 per life year saved are considered expensive, compared to other interventions, which often save life years at $50,000 to $100,000, or even less. The results of this study suggest that finite public health resources might be better spent elsewhere.
The "human cost" of screening suggests its true price may be even higher. Because conditions causing SCD are so rare, even an occasional "false positive" means that for every previously undiagnosed child accurately identified, many children who would never have died from SCD may be labeled as being at-risk.
The research team stressed that the cardiac conditions causing SCD in children are incredibly rare. Many are cardiac conditions are genetic and there may be a family history of early (< 50 years of age) or unexplained SCD in a family member. Dr. Leslie advises that "the most concerning family history in a child is when a parent or sibling is diagnosed with a likely familial cardiac disease; those children should certainly be evaluated." Since some disorders that cause SCD may not be identifiable on an ECG until late adolescence or early adulthood, an ECG in a parent with a positive family history may provide more information than an ECG in a child. Another indication to consult with a doctor is if a child reports any experiences of fainting or shortness of breath with strong emotions or during exertion (not related to a medical condition like asthma).
Funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, the study involved building simulation models incorporating disease prevalence, ECG characteristics, treatment algorithms, and diagnostic and treatment costs to determine the cost-effectiveness ratios. The research team included health policy, health economics, and decision-analytics researchers from Tufts Medical Center and pediatric cardiologists at Children's Hospital Boston. Additional support for the study was provided by the Tufts CTSI, the John R. Grey IV Cardiology Fellowship Endowment Fund, and the Sean Roy Johnson Fund for Electrophysiology Research. The article is available through the journal's website.
About the NIH
The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research. Helping to lead the way toward important medical discoveries that improve people's health and save lives, NIH scientists investigate ways to prevent disease as well as the causes, treatments, and even cures for common and rare diseases. Composed of 27 Institutes and Centers, the NIH provides leadership and financial support to researchers in every state and throughout the world. For more information about NIH and its programs, visit www.nih.gov.
About Tufts Clinical and Translational Science Institute (CTSI)
Tufts CTSI was established in August 2008 with Grant Number UL1 RR025752 from the National Center for Research Resources, now the National Center for Advancing Translational Sciences, National Institutes of Health. A collaboration of organizations, founded by Tufts Medical Center and Tufts University, Tufts CTSI accelerates the translation of laboratory research into clinical use, medical practice and health policy. It connects people to research resources, consultation, and education, and fosters collaboration with scholars of all disciplines and with community members, with the ultimate goal of improving the health of the public. Website: www.tuftsctsi.org.
About Tufts Medical Center
Tufts Medical Center is an exceptional, not-for-profit, 415-bed academic medical center that is home to both a full-service hospital for adults and Floating Hospital for Children. Located in downtown Boston, the Medical Center is the principal teaching hospital for Tufts University School of Medicine. Floating Hospital for Children is the full-service children's hospital of Tufts Medical Center and the principal pediatric teaching hospital of Tufts University School of Medicine. Tufts Medical Center is affiliated with seven community hospitals and with New England Quality Care Alliance, its community physicians' network. For more information, please visit www.tuftsmedicalcenter.org.
About Children's Hospital Cardiovascular Program
The Cardiovascular Program at Children's is the largest pediatric heart program in the United States. For more than 50 years, Children's cardiac specialists and investigators have played a vital role in the field of cardiac research, pioneering treatment approaches and major advances in the care and treatment of children with congenital and acquired heart defects.
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