Key result
Systematic ECG screening at admission for psychiatric inpatients is cost-effective for reducing sudden cardiac death, with an incremental cost-effectiveness ratio of $8,644 per QALY gained.
Why the study?
Does systematic ECG screening at hospital admission reduce sudden cardiac death in a cost-effective manner in adult psychiatric inpatients?
Does systematic ECG screening at hospital admission reduce sudden cardiac death in a cost-effective manner in adult psychiatric inpatients?
Systematic ECG screening at admission in psychiatric hospitals is a highly cost-effective strategy to reduce sudden cardiac death associated with drug-induced long QT syndrome.
Answers are grounded in this paper and cite their sources.
Supports ECG screening on psychiatric admission as cost-effective; leaves open need for prospective trials confirming mortality benefit.
IMPORTANCE: Sudden cardiac death is a leading cause of mortality in psychiatric patients. Long QT (LQT) is common in this population and predisposes to Torsades-de-Pointes (TdP) and subsequent mortality. OBJECTIVE: To estimate the cost-effectiveness of electrocardiographic screening to detect LQT in psychiatric inpatients. DESIGN, SETTING, AND PARTICIPANTS: We built a decision analytic model based on a decision tree to evaluate the cost-effectiveness and utility of LQT screening from a health care perspective. LQT proportion parameters were derived from an in-hospital cross-sectional study. We performed experts' elicitation to estimate the risk of TdP, given extent of QT prolongation. A TdP reduction of 65% after LQT detection was based on positive drug dechallenge rate and through adequate treatment and electrolyte adjustments. The base-case model uncertainty was assessed with one-way and probabilistic sensitivity analyses. Finally, the TdP related mortality and TdP avoidance parameters were varied in a two-way sensitivity analysis to assess their effect on the Incremental Cost-Effectiveness Ratio (ICER). MAIN OUTCOMES AND MEASURES: Costs, Quality Ajusted Life Year (QALY), ICER, and probability of cost effectiveness thresholds ($ 10,000, $25,000, and $50,000 per QALY). RESULTS: In the base-case scenario, the numbers of patients needed to screen were 1128 and 2817 to avoid one TdP and one death, respectively. The ICER of systematic ECG screening was $8644 (95%CI, 3144-82 498) per QALY. The probability of cost-effectiveness was 96% at a willingness-to-pay of $50,000 for one QALY. In sensitivity analyses, results were sensitive to the case-fatality of TdP episodes and to the TdP reduction following the diagnosis of LQT. CONCLUSION AND RELEVANCE: In psychiatric hospitals, performing systematic ECG screening at admission help reduce the number of sudden cardiac deaths in a cost-effective fashion.
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Poncet et al. (2015) studied Psychiatric inpatients at risk of drug-induced long QT and sudden cardiac death (n=6,790). Systematic electrocardiographic (ECG) screening vs. No routine ECG screening was evaluated on Incremental Cost-Effectiveness Ratio (ICER) per QALY (ICER $8644 per QALY, 95% CI 3144-82498). Systematic ECG screening at admission for psychiatric inpatients is cost-effective for reducing sudden cardiac death, with an incremental cost-effectiveness ratio of $8,644 per QALY gained.
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