European Heart Journal Advance Access originally published online on July 13, 2006
European Heart Journal 2006 27(15):1824-1832; doi:10.1093/eurheartj/ehl115
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Cost-effectiveness of neonatal ECG screening for the long QT syndrome
1 Department of Computer Science and Systems, University of Pavia Italy
2 Department of Lung, Blood and Heart, University of Pavia Italy
3 Department of Cardiology, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
4 Molecular Cardiology Laboratories, IRCCS Fondazione S. Maugeri Italy
5 Pediatric Cardiology, Department of Pediatrics, IRCCS Policlinico San Matteo Pavia Italy
Received 10 November 2005; revised 2 June 2006; accepted 8 June 2006; online publish-ahead-of-print 13 July 2006.
* Corresponding author. Tel: +39 0382 503567/673; fax: +39 0382 503002. E-mail address: pjqt{at}compuserve.com
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. The cost for saving one entire life of 70 years would be 820 000. Even by varying model parameters by ±30%, the cost per year of life saved remains between 7400 and 20 400. 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.
Key Words: Long QT syndrome • Sudden infant death syndrome • Neonatal ECG screening • Cost-effectiveness • Sudden death
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