Table 1.
Costs, Effectiveness Assumptions and Test Characteristics.
| Base Case | Low Estimate | Low CI for Simulation | High CI for Simulation | High Estimate | |
|---|---|---|---|---|---|
| Risk SCD/100,000 person-yrs | |||||
| Athlete with Heart Disease | 174(9) | 38(5) | 150 | 200 | 335(1) |
| Athlete no Heart Disease | 0.4(9) | 0.11(5) | 0.3 | 0.5 | 0.8* |
| Disqualified with Heart Disease | 28(9) | 9* | 16 | 50 | 174* |
| Non-Athlete no Heart Disease | 0.2(9) | 0.1* | 0.18 | 0.22 | 0.8* |
| Heart disease prevalence | 1.2(9) | 0.3(2) | 1 | 1.4 | 2.5* |
| Test Characteristics | |||||
| Sensitivity (%) | |||||
| History and Physical | 15(26) | 3(7, 27) | 8 | 25 | 30(28) |
| ECG plus History and Physical | 68(9, 26) | 37(29) | 50 | 73 | 75(8) |
| Specificity (%) | |||||
| History and Physical | 97(9, 28) | 73 (30) | 92 | 98 | 98(23, 26, 31) |
| ECG plus History and Physical | 95(9, 32) | 84(29) | 93 | 97 | 98(26) |
| Costs | |||||
| Screening | |||||
| History and Physical | 73(33)† | 0 | 55 | 84 | 231** |
| ECG | 34(33)† | 5 | 30 | 58 | 304** |
| Evaluation | |||||
| Cardiology visit | 128(33) | 98 | 275** | ||
| Echocardiogram | 253(33) | 171 | 1825** | ||
| Stress Test | 135(33) | 85 | 560** | ||
| Cardiac MR | 1100(33) | 670 | 2200 | ||
| Holter | 380(33) | 110 | 740** | ||
| Cardiac CT | 560* | 360 | 1800 | ||
| Total Cost | 580* | 330 | 400 | 780 | 3000** |
| Treatment for discovered heart disease | |||||
| Cost year one | 5000*‡ | 1000 | 4000 | 6000 | 15000 |
| Cost per year, subsequent years | 350* | 50 | 250 | 450 | 1200 |
Medicare reimbursement cost of $61 plus $12 indirect cost for history and physical and Medicare reimbursement cost of $27 plus $7 indirect cost for ECG.
Author consensus estimates.
Maximum estimates for costs of ECG, echocardiography, exercise testing, Holter monitor, and clinical facility usage charges obtained by averaging charges from a random sampling of twenty California hospitals' chargemasters from 2007 (34). Minimum estimates were derived from averaged charges by using a cost-to-charge ratio of 0.15.
Averaged over secondary test positive population, above baseline medical cost; each identified individual is modeled to have 2 additional clinic visits, additional echocardiography, stress testing, and Holter monitor, and either MRI or CT (average $2500 per individual); electrophysiology study and ablation, cardiac surgery, or implantable cardioverter defibrillator implantation (total 5% of identified individuals; distributed average $1500 per individual); and medications, counseling, other clinic visits, and second opinions ($1500 per individual).