Routine echocardiography screening every 10 years in childhood cancer survivors reduced lifetime CHF risk by 2.3% with an ICER of $111,600 per QALY compared with no assessment.
Does interval-based echocardiography assessment reduce congestive heart failure incidence and improve cost-effectiveness in childhood cancer survivors?
Routine echocardiography screening in childhood cancer survivors may reduce CHF incidence, but less frequent assessment (every 5-10 years) may be more cost-effective than current recommendations of every 1-5 years.
BACKGROUND: Childhood cancer survivors treated with cardiotoxic therapies are recommended to have routine cardiac assessment every 1 to 5 years, but the long-term benefits are uncertain. OBJECTIVE: To estimate the cost-effectiveness of routine cardiac assessment to detect asymptomatic left ventricular dysfunction and of angiotensin-converting enzyme inhibitor and β-blocker treatment to reduce congestive heart failure (CHF) incidence in childhood cancer survivors. DESIGN: Simulation model. DATA SOURCES: Literature, including data from the Childhood Cancer Survivor Study. TARGET POPULATION: Childhood cancer survivors. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: Interval-based echocardiography assessment every 1, 2, 5, or 10 years, with subsequent angiotensin-converting enzyme inhibitor or β-blocker treatment for patients with positive test results. OUTCOME MEASURES: Lifetime risk for systolic CHF, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: The lifetime risk for systolic CHF among 5-year childhood cancer survivors aged 15 years was 18. 8% without routine cardiac assessment (average age at onset, 58. 8 years). Routine echocardiography reduced lifetime risk for CHF by 2. 3% (with assessment every 10 years) to 8. 7% (annual assessment). The ICER for assessment every 10 years was 111 600 per quality-adjusted life-year (QALY) compared with no assessment. Assessment every 5 years had an ICER of 117 900 per QALY, and ICERs for more frequent assessment exceeded 165 000 per QALY. RESULTS OF SENSITIVITY ANALYSIS: Results were sensitive to treatment effectiveness, absolute excess risk for CHF, and asymptomatic left ventricular dysfunction asymptomatic period. The probability that assessment every 10 or 5 years was preferred at a 100 000-per-QALY threshold was 0. 33 for the overall cohort. LIMITATION: Treatment effectiveness was based on adult data. CONCLUSION: Current recommendations for cardiac assessment may reduce CHF incidence, but less frequent assessment may be preferable.
Yeh et al. (Mon,) conducted a other in Childhood cancer survivors. Interval-based echocardiography assessment every 1, 2, 5, or 10 years vs. No assessment was evaluated on Lifetime risk for systolic CHF, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). Routine echocardiography screening every 10 years in childhood cancer survivors reduced lifetime CHF risk by 2.3% with an ICER of $111,600 per QALY compared with no assessment.