Cost-effectiveness of the cardiovascular pre-participation screening in children practicing sport. (11th May 2022) - Graziano, F
Abstract: Funding Acknowledgements: Type of funding sources: None. Introduction: In Italy, preparticipation screening of competitive athletes is mandatory. The age at which pre-participation screening (PPS) should start is established by each sport federation and it is sometimes under 10 years old. The aim of this study is to detect both PPS efficacy and cost in paediatric age and to define the cut-off age from which it is more cost-effective. Methods: We retrospectively enrolled 25251 athletes aged ≤15 to evaluate the prevalence of cardiovascular (CV) diseases and cost-effectiveness ratio who underwent PPS from 2011 to 2020. In addition, we retrospectively studied a subgroup of 1307 competitive athletes aged 7-15 who underwent PPS from January 2019 to February 2020 for an in-depth analysed regarding costs. Cardiovascular preparticipation screening included first-line investigations (history, physical examination, resting ECG and exercise testing) and further examinations in case of abnormalities at first-line tests. Results: In the period 2010-2020, 66 athletes were permanently disqualified for a CV disease (0, 11%), 26 for a CV disease at risk of sudden cardiac death (0.05%), with a prevalence of 0.15% over 12 years old versus 0.01% under 12 (p<0.001). In the cost analysis subgroup, second-line investigations were prescribed to 5% of athletes because of abnormalities at first line tests: 1 was disqualified for a CV disease (0, 07%). The cost for each athlete was 69, 80€. Between 2011 and 2020, 58185 PPS were carried out. The overall cost of PPS was about €4 million, the cost for each diagnosis of any CV disease was 61.535€, and for each CV disease at risk of sudden cardiac death was 156.204€. Conclusion: The cost-effectiveness of PPS before competitive sports in the pediatric age is lower than reported for older athletes in previously published studies. According to our data, starting PPS before 12 years of age does not appear to be justified.