Circ: Screening ped patients for SCD could accrue hefty costs
“After some success was achieved in implementing community-based SCD screening programs for school-aged children in Japan and for athletes in Italy, Israel and the United States, popular interest in pediatric SCD screening increased,” wrote Laurel K. Leslie, MD, MPH, and colleagues from Tufts University School of Medicine in Boston. Children on medication for attention-deficit/hyperactivity disorder (ADHD) and those participating in sports are at higher risk for experiencing SCD. Therefore, many have looked toward ECG screening for these pediatric subpopulations.
To better evaluate the costs and benefits of ECG screening for the two pediatric subpopulations, Leslie et al created a simulation model to determine the cost-effectiveness of targeted SCD screening. The researchers created two algorithms—those for ADHD patients (8 years of age) or those participating in sports (14 years of age). The researchers estimated the incremental costs and impact of screening on lifetime risk of SCD and life expectancy, among others.
“Incremental SCD cases prevented over a lifetime are consistent with our assumptions,” the authors wrote. After screening for the three most common pediatric conditions, the researchers reported that screening would reduce SCD risk by a maximum of 3.6. The authors reported life expectancy increases of 0.8 to 1.6 days per screened individual. Additionally, the incremental cost-effectiveness of screening was $91,000 (screening at 14 years) and $204,000 per life-year (screening at eight years), according to the authors.
“The cost-effectiveness of screening at 14 years of age (approximately $91,000 per life-year gained) is notably more favorable than screening at 8 years of age (approximately $204 000 per life-year gained),” the authors wrote.
After a sensitivity analysis, the authors concluded that baseline mortality and the risk of mortality from stimulant medication use and sports participation had the greatest impact on cost-effectiveness.
“It is undoubtedly true at the individual level that the cost of an ECG is a small price to pay to save the life of a child at risk for SCD,” said the authors. “However, the cost borne by society also reflects resources used for screening and the costs (and risks) associated with further evaluation.”
The study showed that screening for SCD in the two pediatric subpopulations is unfavorable, especially at the threshold currently accepted in society of between $50,000 to $100,000 per life-year.
While the authors urged that economics should not influence medical practice, they said “the finite nature of healthcare expenditures implies that spending on one priority restricts spending on other priorities.
“The fact that the cost-effectiveness ratio for pediatric SCD screening is relatively unfavorable (high) implies that there are opportunities to invest limited healthcare resources in ways that will produce greater health benefits for the population,” the authors summed.