Is LV dysfunction screening in childhood cancer survivors treated with anthracyclines and/or chest-directed RT cost effe
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Is LV dysfunction screening in childhood cancer survivors treated with anthracyclines and/or chest-directed RT cost effective? Screening to detect asymptomatic left ventricular dysfunction (ALVD) that precedes overt heart failure (HF) in survivors of childhood cancer treated with anthracyclines and/or chest-directed radiotherapy (RT) is cost effective for those at high HF risk. This is one of the findings of a study that used a model-based approach to estimate the clinical benefits, costs and cost effectiveness of routine screening echocardiography for cardiomyopathy risk groups as defined by the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) based on cancer-treatment exposure. The model was populated with newly available data from the Childhood Cancer Survivor Study (CCSS) and the St Jude Lifetime Cohort (SJLIFE). The model predicted that lifetime HF risks varied from 16.9% to 36.7% among IGHG risk-stratified survivors of childhood cancer exposed to anthracyclines or chest-directed RT. For high-risk survivors, screening every 2, 5 or 10 years was cost effective, with incremental cost-effectiveness ratios (ICERs) of $US77 877, $37 703 and $34 604 per QALY gained, respectively. The 2-year strategy would be the preferred option, potentially averting 8.4% of HF cases and yielding the greatest QALY gains. For moderate-risk survivors, the preferred strategy is uncertain. For low-risk survivors, however, all strategies had ICERs > $US175 000 per QALY gained. "Our data do not support the costeffectiveness of screening to detect ALVD with echocardiography in low-risk survivors, which in our study population would eliminate screening for approximately 40% of currently screened individuals," note the researchers. Ehrhardt MJ, et al. Cost-Effectiveness of the International Late Effects of Childhood Cancer Guideline Harmonization Group Screening Guidelines to Prevent Heart Failure in 803498339 Survivors of Childhood Cancer. Journal of Clinical Oncology : JCO2000418, 14 Aug 2020. Available from: URL: http://doi.org/10.1200/JCO.20.00418
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Reactions 29 Aug 2020 No. 1819
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