Screening Could Reduce Sudden Cardiac Death in ADHD
Adding ECG to current standard of care could identify more children at risk of sudden death
TUESDAY, March 9 (HealthDay News) -- In children with attention deficit/hyperactivity disorder who are candidates for stimulant medication, adding electrocardiogram (ECG) screening to history and physical examination before treatment may have borderline cost-effectiveness for preventing sudden cardiac death, according to a study published online March 8 in Circulation.
Peter Denchev, Ph.D., of the National Institute of Mental Health in Bethesda, Md., and colleagues used a state-transition Markov model to compare the cost-effectiveness of three screening strategies: performing a history and physical examination with cardiology referral if abnormal (current standard of care); performing a history and physical examination plus ECG after negative history and physical examination, with cardiology referral if either is abnormal; and performing a history and physical examination plus ECG, with cardiology referral only if ECG is abnormal. They assumed that identification of sudden cardiac death-associated cardiac abnormalities would result in exclusion from stimulants and competitive sports.
Compared to the first strategy, the researchers calculated that the expected incremental cost-effectiveness per quality-adjusted life-year for strategies two and three would be $39,300 and $27,200, respectively. They also found that strategies two and three would prevent 13 sudden cardiac deaths per 400,000 children, at a cost per life of $1.6 million for strategy two and $1.2 million for strategy three.
"This is clearly an important first step to answering some very contentious issues, which are not easily addressed by direct observational studies and analysis of population-wide mortality and which will nonetheless have direct effect on pediatric public health policy," state the authors of an accompanying editorial.