Cost-effectiveness of neonatal ECG screening for the long QT syndrome

Abstract

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.