• Jennifer M Yeh, Anju Nohria, and Lisa Diller.
• Ann. Intern. Med. 2014 May 20; 160 (10): 661-71.

BackgroundChildhood cancer survivors treated with cardiotoxic therapies are recommended to have routine cardiac assessment every 1 to 5 years, but the long-term benefits are uncertain.ObjectiveTo estimate the cost-effectiveness of routine cardiac assessment to detect asymptomatic left ventricular dysfunction and of angiotensin-converting enzyme inhibitor and β-blocker treatment to reduce congestive heart failure (CHF) incidence in childhood cancer survivors.DesignSimulation model.Data SourcesLiterature, including data from the Childhood Cancer Survivor Study.Target PopulationChildhood cancer survivors.Time HorizonLifetime.PerspectiveSocietal.InterventionInterval-based echocardiography assessment every 1, 2, 5, or 10 years, with subsequent angiotensin-converting enzyme inhibitor or β-blocker treatment for patients with positive test results.Outcome MeasuresLifetime risk for systolic CHF, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs).Results Of Base Case AnalysisThe lifetime risk for systolic CHF among 5-year childhood cancer survivors aged 15 years was 18.8% without routine cardiac assessment (average age at onset, 58.8 years). Routine echocardiography reduced lifetime risk for CHF by 2.3% (with assessment every 10 years) to 8.7% (annual assessment). The ICER for assessment every 10 years was $111 600 per quality-adjusted life-year (QALY) compared with no assessment. Assessment every 5 years had an ICER of $117 900 per QALY, and ICERs for more frequent assessment exceeded $165 000 per QALY.Results Of Sensitivity AnalysisResults were sensitive to treatment effectiveness, absolute excess risk for CHF, and asymptomatic left ventricular dysfunction asymptomatic period. The probability that assessment every 10 or 5 years was preferred at a $100 000-per-QALY threshold was 0.33 for the overall cohort.LimitationTreatment effectiveness was based on adult data.ConclusionCurrent recommendations for cardiac assessment may reduce CHF incidence, but less frequent assessment may be preferable.

33 keywords...

hide…