Routine echocardiography screening every 2 years was cost-effective for high-risk childhood cancer survivors ($77,880 per QALY gained), whereas screening was not cost-effective for low-risk survivors.
Does interval-based screening echocardiography improve cost-effectiveness and reduce lifetime HF risk in survivors of childhood cancer?
Routine echocardiographic screening for heart failure is cost-effective for high- and moderate-risk childhood cancer survivors but not for low-risk survivors, suggesting a need to refine current guidelines.
PURPOSE: Survivors of childhood cancer treated with anthracyclines and/or chest-directed radiation are at increased risk for heart failure (HF). The International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms, but evidence supporting its frequency and cost-effectiveness is limited. PATIENTS AND METHODS: and ≥ 15 Gy]). We compared 1-, 2-, 5-, and 10-year interval-based screening with no screening. Screening performance and treatment effectiveness were estimated based on published studies. Costs and quality-of-life weights were based on national averages and published reports. Outcomes included lifetime HF risk, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs 175, 000 per QALY gained for all strategies for low-risk survivors, representing approximately 40% of those for whom screening is currently recommended. CONCLUSION: Our findings suggest that refinement of recommended screening strategies for IGHG high- and low-risk survivors is needed, including careful reconsideration of discontinuing asymptomatic left ventricular dysfunction and HF screening in low-risk survivors.
Ehrhardt et al. (2020) studied Heart failure in survivors of childhood cancer (n=27,307). Routine echocardiography screening vs. No screening was evaluated on Incremental cost-effectiveness ratio (ICER) per QALY gained. Routine echocardiography screening every 2 years was cost-effective for high-risk childhood cancer survivors ($77,880 per QALY gained), whereas screening was not cost-effective for low-risk survivors.
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