Cost-effectiveness and implications of newborn screening for prolongation of QT interval for the prevention of sudden infant death syndrome

Objective: To determine the cost-effectiveness of universal and high-risk n eonatal electrocardiographic (ECG) screening for QT prolongation as a predi ctor of sudden infant death syndrome (SIDS) risk in a theoretical group of neonates. Study design: Incremental cost-effectiveness analysis with decision analyti c modeling. A hypothetical cohort of healthy term infants was modeled, comp aring options of no screening, high-risk neonate screening, and universal s creening. The high-risk strategy is speculative, because no currently accep ted methodology is known for identifying infants at high risk for SIDS. Giv en the uncertain mechanisms of association between prolonged corrected QT i nterval (QTc) and SIDS, analyses were repeated under different assumptions. Sensitivity analyses were also performed on all input variables for both c osts and effectiveness. Results: Under the assumption that nconatal electrocardiographic screening detects long QT syndrome responsive to conventional therapy, the cost-effec tiveness of high-risk screening was $3403 per life year gained, whereas uni versal screening cost $18,465 per additional life year gained. However, if the effectiveness of SIDS therapy falls below 10%, the cost-effectiveness d eteriorates to $25,376 per life year saved for the high-risk strategy and $ 118,900 for universal screening. The analyses were robust to a broad array of sensitivity analyses. Conclusions: The acceptability of the cost-effectiveness of neonatal electr ocardiographic screening is heavily dependent on the pathophysiologic; mech anism of SIDS and on the efficacy of monitoring and antiarrhythmic treatmen t. The nature of this association must be elucidated before routine neonata l electrocardiographic screening is war-ranted.