The Cost Effectiveness Analysis of Electrocardiogram Screening Program for Prevention of Sudden Cardiac Death in Japan

INTRODUCTION: To prevent sudden cardiac death (SCD) of hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQTS) in youth is an important public health initiative. In Japan, students were examined by electrocardiograms (ECG) at 6, 12, and 15 years to detect high risk ones. But we have not the evidence of cost effectiveness of this examination. The objective of this study is to clarify it in Japan.

METHOD: For the life parameters, the number of six year people (1,061,000) was obtained by the estimated population of Japan at Oct 1st in 2012, and the death rate of each age-stratum of each year was obtained by vital statistics, respectively. The prevalence of HCM was estimated 1/68,000 (six-year children), 1/20,000 (twelve-year children) by the averaged values in medical examination records obtained by six prefectures in Japan, and the prevalence of LQTS was obtained by Kagoshima medical examination records. We assumed the precision parameters of the examination (sensitivity, specificity, etc) were same as a previous work (Anderson BR, et al. Pediatr Cardiol, 2013). For cost parameters, the examinations’ were obtained by Kagoshima medical examination records. Because there was a report which showed the death declined 60% by the comparison in the period between pre-examination and post-examination, we assumed it for the effectiveness for preventing death rate by treatment. We applied Markov transition model for the analysis.

RESULTS: The life-years saved by the both examinations was 66,879 [person-years], and the cost was 23,743,000,000 [yen] ($ 232,000,000). Incremental cost-effectiveness ratio (ICER) was 355,020 [yen/ person-years] ($3,481 [1/person-years]), which was less than $41,400 (Anderson BR, et al.).

CONCLUSION: The cost effectiveness of Electrocardiogram Screening Program was firstly estimated in Japan as $3,481 per person-years. ($1≒102 yen)