Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T06:11:49.612Z Has data issue: false hasContentIssue false

CARDIOVASCULAR SCREENING OF YOUNG ATHLETES: A REVIEW OF ECONOMIC EVALUATIONS

Published online by Cambridge University Press:  24 April 2017

Sophie Gerkens
Affiliation:
Belgian Health Care Knowledge Centre (KCE)[email protected]
Hans Van Brabandt
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Anja Desomer
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Christian Leonard
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Mattias Neyt
Affiliation:
Belgian Health Care Knowledge Centre (KCE)

Abstract

Objectives: Some experts have promoted preparticipative cardiovascular screening programs for young athletes and have claimed that such programs were cost-effective without performing a critical analysis of studies supporting this statement. In this systematic review, a critical assessment of economic evaluations on these programs is performed to determine if they really provide value for money.

Methods: A systematic review of economic evaluations was performed on December 24, 2014. Web sites of health technology assessment agencies, the Cochrane database of systematic review, the National Health Service Economic Evaluation Database of the Cochrane Library, EMBASE, Medline, Psychinfo, and EconLit were searched to retrieve (reviews of) economic evaluations. No language or time restrictions were imposed and predefined selection criteria were used. Selected studies were critically assessed applying a structured data extraction sheet.

Results: Five relevant economic evaluations were critically assessed. Results of these studies were mixed. However, those in favor of screening made (methodological) incorrect choices, of which the most important one was not taking into account a no-screening alternative as comparator. Compared with no screening, other strategies (history and physical examination or history and physical examination plus electrocardiogram) were not considered cost-effective.

Conclusions: Results of primary economic evaluations should not be blindly copied without critical assessment. Economic evaluations in this field lack the support of robust evidence. Negative consequences of screening (false positive findings, overtreatment) should also be taken into account and may cause more harm than good. A mass screening of young athletes for cardiovascular diseases does not provide value for money and should be discouraged.

Type
Assessments
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Wiffen, P, Clarcke, A. Screening to reduce sudden cardiac death in people aged 12-39 years: An appraisal against UKNSC criteria. London: UK: National Screening Committee; 2014.Google Scholar
2. Maron, BJ, Thompson, PD, Ackerman, MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation. 2007;115:16431655.CrossRefGoogle ScholarPubMed
3. Zipes, DP, Camm, AJ, Borggrefe, M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006;8:746837.Google Scholar
4. Bille, K, Figueiras, D, Schamasch, P, et al. Sudden cardiac death in athletes: The Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil. 2006;13:859875.Google Scholar
5. Corrado, D, Pelliccia, A, Bjornstad, HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: Proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:516524.CrossRefGoogle Scholar
6. Corrado, D, Schmied, C, Basso, C, et al. Risk of sports: Do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J. 2011;32:934944.Google Scholar
7. Van Brabandt, H, Desomer, A, Gerkens, S, Neyt, M. Harms and benefits of screening young people to prevent sudden cardiac death. BMJ. 2016;353:i1156.Google Scholar
8. Wilson, JMG, Junger, G. Principles and practice of screening for disease. Geneva: World Health Organisation (WHO); 1968.Google ScholarPubMed
9. Desomer, A, Gerkens, S, Vinck, I, et al. Cardiovascular pre-participation screening in young athletes. Brussels: Belgian Health Care Knowledge Centre (KCE); 2015.Google Scholar
10. AMSTAR [Internet]. Assessing the methodological quality of systematic reviews: The development of AMSTAR. Ottawa: Bruyère Research Institute; 2015. http://amstar.ca/Amstar_Checklist.php (accessed July 2016).Google Scholar
11. ANAES. How to judge a proposal for a screening programme. Paris: Agence nationale d'accréditation et d'évaluation en santé; 2004.Google Scholar
12. Cleemput, I, Neyt, M, Van de Sande, S, Thiry, N. Belgian guidelines for economic evaluations and budget impact analyses: Second edition. Health Technology Assessment (HTA). Brussels: Belgian Health Care Knowledge Centre (KCE); 2012.Google Scholar
13. Fuller, CM. Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc. 2000;32:887890.Google Scholar
14. Halkin, A, Steinvil, A, Rosso, R, Adler, A, Rozovski, U, Viskin, S. Preventing sudden death of athletes with electrocardiographic screening: What is the absolute benefit and how much will it cost? J Am Coll Cardiol. 2012;60:22712276.Google Scholar
15. Leslie, LK, Cohen, JT, Newburger, JW, et al. Costs and benefits of targeted screening for causes of sudden cardiac death in children and adolescents. Circulation. 2012;125:26212629.CrossRefGoogle ScholarPubMed
16. Malhotra, R, West, JJ, Dent, J, et al. Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: A 5-year experience. Heart Rhythm. 2011;8:721727.Google Scholar
17. Menafoglio, A, Di Valentino, M, Segatto, JM, et al. Costs and yield of a 15-month preparticipation cardiovascular examination with ECG in 1070 young athletes in Switzerland: Implications for routine ECG screening. Br J Sports Med. 2014;48:11571161.CrossRefGoogle ScholarPubMed
18. Schoenbaum, M, Denchev, P, Vitiello, B, Kaltman, JR. Economic evaluation of strategies to reduce sudden cardiac death in young athletes. Pediatrics. 2012;130:e380-e389.Google Scholar
19. Wheeler, MT, Heidenreich, PA, Froelicher, VF, Hlatky, MA, Ashley, EA. Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med. 2010;152:276286.Google Scholar
20. Siegel, JE, Torrance, GW, Russell, LB, Luce, BR, Weinstein, MC, Gold, MR. Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost Effectiveness in Health and Medicine. Pharmacoeconomics. 1997;11:159168.Google Scholar
21. Neyt, M, Van Brabandt, H. The importance of the comparator in economic evaluations: Working on the efficiency frontier. Pharmacoeconomics. 2011;29:913916.Google Scholar
22. Corrado, D, Basso, C, Pavei, A, Michieli, P, Schiavon, M, Thiene, G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:15931601.CrossRefGoogle ScholarPubMed
23. Corrado, D, Basso, C, Rizzoli, G, Schiavon, M, Thiene, G. Does sports activity enhance the risk of sudden cardiac death in adolescents and young adults? J Am Coll Cardiol. 2003;42:19591963.Google Scholar
24. Haskell, W. Physical Activity Guidelines Advisory Committee Report. Washington: Physical Activity Guidelines Advisory Committee; 2008.Google Scholar
25. Drezner, JA, Ackerman, MJ, Anderson, J, et al. Electrocardiographic interpretation in athletes: The ‘Seattle criteria’. Br J Sports Med. 2013;47:122124.Google Scholar
26. Sharma, S, Merghani, A, Gati, S. Cardiac screening of young athletes prior to participation in sports: Difficulties in detecting the fatally flawed among the fabulously fit. JAMA. 2015;175:125127.Google Scholar
27. Magalski, A, McCoy, M, Zabel, M, et al. Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes. Am J Med. 2011;124:511518.Google Scholar
28. Estes, NA, Link, MS. Preparticipation athletic screening including an electrocardiogram: An unproven strategy for prevention of sudden cardiac death in the athlete. Prog Cardiovasc Dis. 2012;54:451454.Google Scholar
29. Link, MS, Estes, NA. Sudden cardiac death in the athlete: Bridging the gaps between evidence, policy, and practice. Circulation. 2012;125:25112516.Google Scholar
Supplementary material: File

Gerkens supplementary material

Table S1

Download Gerkens supplementary material(File)
File 17.8 KB
Supplementary material: File

Gerkens supplementary material

Table S2

Download Gerkens supplementary material(File)
File 15.5 KB
Supplementary material: File

Gerkens supplementary material

Table S3

Download Gerkens supplementary material(File)
File 15.8 KB
Supplementary material: File

Gerkens supplementary material

Table S4

Download Gerkens supplementary material(File)
File 18 KB