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Cost-effectiveness of electrocardiography vs. electrocardiography plus limited echocardiography to diagnose LVH in young, newly identified, hypertensives.

Publication ,  Journal Article
Leese, PJ; Viera, AJ; Hinderliter, AL; Stearns, SC
Published in: Am J Hypertens
June 2010

BACKGROUND: In the United States, screening for left ventricular hypertrophy (LVH) in a newly diagnosed hypertensive patient is typically performed using electrocardiography (ECG). Echocardiography (echo) is a more accurate but also more expensive procedure. However, the introduction of limited echo within the past decade has made sonographic imaging of the heart less expensive and more available for routine screening. METHODS: The cost per additional correct diagnosis of LVH for ECG vs. ECG plus limited echo (with limited echo utilized in patients without ECG evidence of LVH) was analyzed using decision analytic modeling. A structured literature search was used to parameterize model probabilities, and costs are based on the 2008 Medicare Physician Fee Schedule. The study population consisted of black and white cohorts ~50 years of age with new diagnosis of hypertension. Outcomes included short-term results of LVH screening and diagnosis, and the study perspective was health system. RESULTS: Base-case results indicate each additional correct LVH diagnosis by ECG plus limited echocardiography instead of ECG cost $655 in the black cohort and $829 in the white cohort. Results in both cohorts were most sensitive to the cost of echocardiography. Simulation-generated cost-effectiveness acceptability curves demonstrated costs per additional correct diagnosis have a 90% likelihood of being below $993 and $1,420 in the black and white cohorts, respectively. CONCLUSIONS: LVH detection by ECG plus limited echocardiography may be an economically feasible alternative to ECG due to increased accuracy. However, final recommendations require analysis of long-term effects on morbidity, mortality, quality of life, and subsequent treatment costs between the diagnostic approaches.

Duke Scholars

Published In

Am J Hypertens

DOI

EISSN

1941-7225

Publication Date

June 2010

Volume

23

Issue

6

Start / End Page

592 / 598

Location

United States

Related Subject Headings

  • White People
  • Sensitivity and Specificity
  • Middle Aged
  • Hypertrophy, Left Ventricular
  • Hypertension
  • Humans
  • Electrocardiography
  • Echocardiography
  • Decision Trees
  • Cost-Benefit Analysis
 

Citation

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Leese, P. J., Viera, A. J., Hinderliter, A. L., & Stearns, S. C. (2010). Cost-effectiveness of electrocardiography vs. electrocardiography plus limited echocardiography to diagnose LVH in young, newly identified, hypertensives. Am J Hypertens, 23(6), 592–598. https://doi.org/10.1038/ajh.2010.42
Leese, Peter J., Anthony J. Viera, Alan L. Hinderliter, and Sally C. Stearns. “Cost-effectiveness of electrocardiography vs. electrocardiography plus limited echocardiography to diagnose LVH in young, newly identified, hypertensives.Am J Hypertens 23, no. 6 (June 2010): 592–98. https://doi.org/10.1038/ajh.2010.42.
Leese, Peter J., et al. “Cost-effectiveness of electrocardiography vs. electrocardiography plus limited echocardiography to diagnose LVH in young, newly identified, hypertensives.Am J Hypertens, vol. 23, no. 6, June 2010, pp. 592–98. Pubmed, doi:10.1038/ajh.2010.42.
Journal cover image

Published In

Am J Hypertens

DOI

EISSN

1941-7225

Publication Date

June 2010

Volume

23

Issue

6

Start / End Page

592 / 598

Location

United States

Related Subject Headings

  • White People
  • Sensitivity and Specificity
  • Middle Aged
  • Hypertrophy, Left Ventricular
  • Hypertension
  • Humans
  • Electrocardiography
  • Echocardiography
  • Decision Trees
  • Cost-Benefit Analysis