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Cited by 38Attention Deficit Hyperactivity DisorderHealth Systems, Economic Evaluations, Quality of LifeCardiac pacing and defibrillation studies

Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder

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Denchev, Peter, Kaltman, Jonathan R., Schoenbaum, Michael, Vitiello, Benedetto·2010·Circulation
DOI 10.1161/circulationaha.109.901256
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Abstract

Background— Stimulants are widely used to treat children with attention deficit/hyperactivity disorder and may increase the risk for sudden cardiac death (SCD). We examined the cost-effectiveness of pretreatment screening with ECG for reducing SCD risk in children diagnosed with attention deficit/hyperactivity disorder who are candidates for stimulant medication. Method and Results— We constructed a state-transition Markov model with 10 annual cycles spanning 7 to 17 years of age. Taking a societal perspective, we compared the cost-effectiveness of 3 screening strategies: (1) performing a history and physical examination with cardiology referral if abnormal (current standard of care); (2) performing a history and physical examination plus ECG after negative history and physical examination, with cardiology referral if either is abnormal; and (3) performing a history and physical examination plus ECG, with cardiology referral only if ECG is abnormal. Children identified with SCD-associated cardiac abnormalities would be restricted from stimulants and from playing competitive sports. The expected incremental cost-effectiveness over strategy 1 was $39 300 and $27 200 per quality-adjusted life-year for strategies 2 and 3, respectively. Monte Carlo simulation found that the chance of incremental cost-effectiveness was 55% for strategy 2 and 71% for strategy 3 (willingness to pay ≤$50 000 per quality-adjusted life-year). Both strategies 2 and 3 would avert 13 SCDs per 400 000 children seeking stimulant treatment for ADHD, for a cost of $1.6 million per life for strategy 2 and $1.2 million per life for strategy 3. Conclusions— Relative to current practice, adding ECG screening to history and physical examination pretreatment screening for children with attention deficit/hyperactivity disorder has borderline cost-effectiveness for preventing SCD. Relative cost-effectiveness may be improved by basing cardiology referral on ECG alone. Benefits of ECG screening arise primarily by restricting children identified with SCD risk from competitive sports.

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  • ECG screening is not currently considered cost-effective or appropriate for prevention of sudden death in the general paediatric population in Europe (or the US).

    “ECG screening is, however, not currently considered cost-effective or appropriate for prevention of sudden death in the general paediatric population in Europe (or the US), for example, as reported by Denchev et al. [32] in a recent economic evaluation of the issue.”

    From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [32]

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Research works printed but not linked: 2

  1. American Academy of Child and Adolescent Psychiatry. Practice param- eter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psy- chiatry. 2007;46:894 -921.
  2. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. JAMA. 1996;276:199 -204.

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Related

Authors
Denchev, P., Kaltman, J. R., Schoenbaum, M., & Vitiello, B.
Affiliations
National Institutes of Health (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-03-23
Volume
121
Issue
11
Pages
1329-1337
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.109.901256
OpenAlex
W2157848721
Cited by
38
References
34
Citations by year
2022: 2 · 2021: 1 · 2020: 1 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 3 · 2012: 10
FWCI
5.45
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders
  • U.S. Department of Health and Human Services
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute
  • National Institute of Mental Health
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
sudden cardiac death, attention deficit hyperactivity disorder, stimulant medication, electrocardiogram screening, pre-treatment screening, cost-effectiveness, children, cardiologist referral, sports participation restrictions, quality-adjusted life years
MeSH terms
Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Cost-Benefit Analysis, Electrocardiography, Female, Humans, Male, Markov Chains, Mass Screening, Medical History Taking, Physical Examination, Risk Factors, United States, Models, Statistical, Incidence, Death, Sudden, Cardiac, Quality-Adjusted Life Years

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