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

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Listed:
  • Antoine Poncet
  • Baris Gencer
  • Marc Blondon
  • Marianne Gex-Fabry
  • Christophe Combescure
  • Dipen Shah
  • Peter J Schwartz
  • Marie Besson
  • François R Girardin

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.

Suggested Citation

  • Antoine Poncet & Baris Gencer & Marc Blondon & Marianne Gex-Fabry & Christophe Combescure & Dipen Shah & Peter J Schwartz & Marie Besson & François R Girardin, 2015. "Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-14, June.
    • Handle: RePEc:plo:pone00:0127213
    DOI: 10.1371/journal.pone.0127213
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    References listed on IDEAS

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    1. Patrick W. Sullivan & Vahram Ghushchyan, 2006. "Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States," Medical Decision Making, , vol. 26(4), pages 410-420, July.
    2. Bogdan Grigore & Jaime Peters & Christopher Hyde & Ken Stein, 2013. "Methods to Elicit Probability Distributions from Experts: A Systematic Review of Reported Practice in Health Technology Assessment," PharmacoEconomics, Springer, vol. 31(11), pages 991-1003, November.
    3. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
    4. McCabe, C & Claxton, K & Culyer, AJ, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," MPRA Paper 26466, University Library of Munich, Germany.
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    1. Christopher J. Cadham & Marie Knoll & Luz María Sánchez-Romero & K. Michael Cummings & Clifford E. Douglas & Alex Liber & David Mendez & Rafael Meza & Ritesh Mistry & Aylin Sertkaya & Nargiz Travis , 2022. "The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review," Medical Decision Making, , vol. 42(5), pages 684-703, July.

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