Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder
Modeled Economic Evaluation of Alternative Strategies to Reduce Sudden Cardiac Death Among Children Treated for Attention Deficit/Hyperactivity Disorder
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DOI：
10.1161/circulationaha.109.901256
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发表时间：
2010-03-23
期刊：
影响因子：
37.8
通讯作者：
Vitiello, Benedetto
中科院分区：
文献类型：
--
作者：
Denchev, Peter;Kaltman, Jonathan R.;Vitiello, Benedetto
背景-兴奋剂广泛用于治疗患有注意力缺陷/多动障碍的儿童，并可能增加心源性猝死 (SCD) 的风险。我们检查了使用心电图进行治疗前筛查以降低被诊断为注意力缺陷/多动症且适合接受兴奋剂药物的儿童的 SCD 风险的成本效益。方法和结果 - 我们构建了一个状态转换马尔可夫模型，其中 10 个年度周期跨越 7 至 17 岁。从社会角度来看，我们比较了 3 种筛查策略的成本效益：（1）进行病史和体格检查，如果异常则转诊至心脏病科（当前护理标准）； (2) 询问病史和体格检查，在病史和体格检查阴性后进行心电图检查，如果有异常则转诊心脏病科； (3) 进行病史询问、体格检查以及心电图检查，仅当心电图异常时才转诊心脏病科。患有 SCD 相关心脏异常的儿童将被限制使用兴奋剂和参加竞技运动。与策略 1 相比，策略 2 和策略 3 的预期增量成本效益分别为每个质量调整生命年 39 300 美元和 27 200 美元。蒙特卡罗模拟发现，策略 2 增加成本效益的机会为 55%，策略 3 为 71%（支付意愿）
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