Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis

Details

Serval ID
serval:BIB_FD170FC7A67E
Type
Article: article from journal or magazin.
Collection
Publications
Title
Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis
Journal
PLoS One
Author(s)
Poncet A., Gencer B., Blondon M., Gex-Fabry M., Combescure C., Shah D., Schwartz P. J., Besson M., Girardin F. R.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2015
Volume
10
Number
6
Pages
e0127213
Language
english
Notes
Poncet, Antoine
Gencer, Baris
Blondon, Marc
Gex-Fabry, Marianne
Combescure, Christophe
Shah, Dipen
Schwartz, Peter J
Besson, Marie
Girardin, Francois R
eng
Research Support, Non-U.S. Gov't
PLoS One. 2015 Jun 12;10(6):e0127213. doi: 10.1371/journal.pone.0127213. eCollection 2015.
Abstract
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.
Keywords
Adult, Arrhythmias, Cardiac, Brugada Syndrome, Cardiac Conduction System Disease, *Cost-Benefit Analysis, Death, Sudden, Cardiac/*epidemiology/*etiology, *Electrocardiography/economics, Female, Heart Conduction System/abnormalities, Humans, Male, Mass Screening, Mental Disorders/*complications/*epidemiology, Middle Aged, Prevalence, Probability, Quality-Adjusted Life Years, Risk Factors, Torsades de Pointes/complications/diagnosis/epidemiology, Young Adult
Pubmed
Create date
10/02/2021 12:32
Last modification date
11/02/2021 7:26
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