AIM: Screening student athletes with ECG reduces costs, adds life years
Compared with no screening, screening young athletes with a 12-lead ECG, coupled with cardiovascular-focused history and physical exams, can significantly reduce costs and add years of life, according to a study published in the March 2 issue of the Annals of Internal Medicine.

“Young athletes are the healthiest members of society, yet more than 90 competitive young athletes die suddenly and unexpectedly in the United States each year,” the authors wrote.

To analyze the comparison between screening student athletes aged 14 to 22 via ECG and not screening, Matthew T. Wheeler, MD, PhD, of Stanford University School of Medicine, and colleagues used a decision-analysis, cost-effectiveness model to evaluate 3.7 million competitive athletes involved in high-risk activity in the U.S.

The researchers based their own methods on a European study by the Italian Ministry of Health, which since 1982 has required athletes be screened with history, physical exam and ECG. The study found that in Italy sudden death during competition has decreased by almost 90 percent since screening began.

In addition, researchers used annual medical costs from the 2004 National Center for Health Statistics and from 2004 Medicare reimbursement schedules and the Consumer Price Index.

Researchers found that adding an ECG to athlete screenings cost $88 per athlete, but saved 2.1 life-years per 1,000 athletes. In addition, these data yielded a cost-effectiveness ratio of $42,900 per life-year saved compared to those who were screened only for cardiovascular history and with a physical exam. Compared with athletes who underwent no screening at all, screening with an ECG saved 2.6 life years per 1,000 athletes, cost $199 per athlete and yielded a cost-effectiveness ratio of $74,100 per life-year saved.

"The cost-effectiveness ratio means you spend more money screening, but you also get benefits by reducing deaths," said the study’s co-author Mark Hlatky, MD. "Procedures under $50,000 per life-year added are generally accepted in the U.S. as cost effective. Procedures over $100,000 are often not," he concluded.

In an accompanying editorial, Barry J. Maron, MD, of the Minneapolis Heart Institute Foundation, said that the use of ECGs during athlete screenings may not be feasible in the U.S., and that the “screening of general populations for diseases responsible for sudden death in athletes is a far more complex venture than it might seem initially.”

While European nations have shown that the addition of ECG to athlete screening tests may work, Maron said the lofty population of student athletes alone in the U.S. would deliver problems in adding an ECG to these screening tests. “A multitude of factors reinforce the impracticality of creating such a massive and expensive governmental program within the U.S. medical system, confined to only athletes and administered long-term,” he noted.

In addition, Maron said that “physician resources simply do not exist in the U.S. (or probably any other country), and consequently, a nationwide screening program would create substantial additional burden to an already overworked and over-committed physician workforce.”

Maron concluded that while sudden cardiac death in young athletes is “tragic,” it happens in less than 100 cases annually in the U.S.