Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes

Ann Intern Med. 2010 Mar 2;152(5):276-86. doi: 10.7326/0003-4819-152-5-201003020-00005.


Background: Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness.

Objective: To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening.

Design: Decision-analysis, cost-effectiveness model.

Data sources: Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data.

Target population: Competitive athletes in high school and college aged 14 to 22 years.

Time horizon: Lifetime.

Perspective: Societal.

Intervention: Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease.

Outcome measure: Incremental health care cost per life-year gained.

Results of base-case analysis: Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000).

Results of sensitivity analysis: Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening.

Limitations: Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries.

Conclusion: Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective.

Primary funding source: Stanford Cardiovascular Institute and the Breetwor Foundation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Athletes*
  • Cardiovascular Diseases / diagnosis
  • Computer Simulation
  • Cost-Benefit Analysis
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / prevention & control*
  • Decision Support Techniques
  • Electrocardiography / economics*
  • Electrocardiography / methods
  • Female
  • Humans
  • Male
  • Mass Screening / economics*
  • Mass Screening / methods*
  • Physical Examination / economics
  • Prevalence
  • Sensitivity and Specificity
  • Students*
  • Young Adult