Study Looks At Cost-Effectiveness of ECG in Hyperactive Kids
MONDAY March 8, 2010 -- Electrocardiogram screening to check for heart problems in hyperactive children before prescribing stimulant medications may help identify those at risk, but is only borderline cost-effective compared to the current practice of taking a patient history and doing a physical examination, a new study shows.
Stimulant medications -- such as Ritalin, Concerta and Adderall -- that are used to treat attention-deficit/hyperactivity disorder boost pulse rate and may increase the risk of sudden cardiac death in children with some types of heart conditions.
In this study, U.S. National Institutes of Health researchers used a cost-effectiveness model to compare three strategies:
- Strategy 1. Current standard of care -- a history, physical exam and referral of children with potential problems to a cardiologist.
- Strategy 2. Conduct an ECG only on children with a normal history and physical, and refer those with suspicious findings on either the history/physical or ECG to a cardiologist. Compared to strategy 1, this approach would save an additional 13 children from sudden cardiac death for every 400,000 children screened. The cost would be $1.6 million per additional life saved and an estimated $39,300 per quality-adjusted life year saved.
- Strategy 3. Conduct an ECG on all children, as well as a history and physical, and refer only those with an abnormal ECG to a cardiologist. Compared to strategy 1, this approach would also save an additional 13 children from sudden cardiac death for every 400,000 who are screened. The cost would be $1.2 million per additional life saved and about $27,200 per quality-adjusted life year saved.
Lives typically would be saved by barring at-risk children from playing sports, the researchers said.
"We're not making a recommendation, but providing one type of analysis so others can determine what makes sense in the real world," study co-author Dr. Jonathan Kaltman, a medical officer in the heart development and structural diseases branch of the U.S. National Heart, Lung, and Blood Institute, said in a news release.
The study findings are published in the March 8 online edition of the journal Circulation.
"Preventing sudden cardiac death in children is an important issue," Dr. Paul Matherne, chair of the American Heart Association's Council on Cardiovascular Disease in the Young, said in the news release. "While this study has limitations and is not conclusive, it does offer new approaches and insights that add to our understanding of preventing sudden death. Importantly, it highlights the need for more research into both screening to identify children at risk for sudden death, and for developing new therapies to treat these conditions."
The U.S. National Heart, Lung, and Blood Institute has more about sudden cardiac arrest.
Posted: March 2010