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European Heart Journal Advance Access published online on July 13, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl115
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received November 10, 2005
Revised June 2, 2006
Accepted June 8, 2006

Clinical research

Cost-effectiveness of neonatal ECG screening for the long QT syndrome

Silvana Quaglini 1, Carla Rognoni 1, Carla Spazzolini 2, Silvia G. Priori 3, Savina Mannarino 4, and Peter J. Schwartz 2 *

1 Department of Computer Science and Systems, University of Pavia, Italy
2 Department of Lung, Blood and Heart, University of Pavia, Italy; Department of Cardiology, IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy
3 Department of Lung, Blood and Heart, University of Pavia, Italy; Molecular Cardiology Laboratories, IRCCS Fondazione S. Maugeri, Italy
4 Pediatric Cardiology, Department of Pediatrics, IRCCS Policlinico San Matteo Pavia, Italy

* To whom correspondence should be addressed.
Peter J. Schwartz, E-mail: pjqt{at}compuserve.com


  Abstract

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: {euro}11 740. The cost for saving one entire life of 70 years would be {euro}820 000. Even by varying model parameters by ±30%, the cost per year of life saved remains between {euro}7400 and {euro}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.

Keywords: Long QT syndrome; Sudden infant death syndrome; Neonatal ECG screening; Cost-effectiveness; Sudden death.
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