Targeted preventive cardiac screening in US athletes ‘would limit cost’

By Helen Albert, Senior medwireNews Reporter

Research published in the Journal of the American College of Cardiology suggests that a national echocardiographic (ECG) screening program for US athletes would be prohibitively expensive.

However, in an accompanying editorial, Antonio Pellicia (Institute of Sport Medicine and Science, Rome, Italy) says that the cost estimates made by the study's authors are too high, and that screening would cost a lot less if simplified and tailored to the target population.

Sami Viskin, Tel-Aviv Medical-Center, Israel, and colleagues estimated costs for a national ECG screening program in the USA using athlete characteristic and physician performance data from a previous Italian study, which showed that such screening significantly reduces the risk for sudden cardiac death in this population.

They estimated that a 20-year screening program in the USA including all young competitive athletes would cost somewhere between US$ 51 and 69 billion (€ 39 and 53 billion) and would save approximately 4813 lives.

This translates to a mean cost per life saved of between US$ 10.6 and 14.4 million (€ 8.2 and 11.1 million), which Viskin and team say would make screening too expensive to roll out on a national scale.

Pellicia puts forward the argument that costs can be reduced from the mean estimated cost of US$ 263 (€ 203) for each athlete (for a history, physical exam, and an ECG) to around US$ 60 (€ 50) by tailoring the screening to the population. This is the price currently charged in Italy.

He explains that the population undergoing pre-participation screening are largely young and healthy, and can therefore be screened in an out-of-hospital environment such as at a school or college and by physicians rather than cardiologists, unless called back for a second assessment, which only applies to a minority of individuals. The history, physical exam, and ECG can also all be together and charged as a preventive package rather than as individual units.

However, American College of Cardiology president William Zoghbi, who was not directly involved in the study, maintains that money is not the only consideration in this case.

"While this research focuses on the monetary costs of mandatory ECG screening, it is important to consider the human costs of false positives, which can result in additional potentially unnecessary tests and removal from play of athletes who are not actually at risk," he told the press.

"Most in this discussion agree that physicals, thorough family histories, targeted testing with ECG and other modalities when needed, widespread training in [cardio pulmonary resuscitation], and availability of automated external defibrillators save lives from sudden cardiac arrest."

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