Less frequent echocardiographic screening of childhood cancer survivors is effective for detecting asymptomatic left ventricular dysfunction (ALVD) and is more cost-effective than following the widely accepted Children's Oncology Group (COG) screening guidelines, according to two separate articles being published in Annals of Internal Medicine. More than half of all childhood cancers are treated with anthracyclines, a highly effective chemotherapeutic agent that increases risk for ALVD, subsequent heart failure, and death. As such, the COG developed Long-Term Follow Up Guidelines for Survivors for Childhood, Adolescent, and Young Adult Cancers in 2003, recommending periodic lifetime echocardiography screening to detect ALVD. In two separate analyses, researchers reviewed the guidelines and also looked at alternative screening schedules to determine effectiveness and cost-effectiveness of the different approaches.
In the first study, researchers used a computer model to simulate the life histories of 10 million childhood cancer survivors from five years after cancer diagnosis until death for each of the 12 risk profiles outlined in the COG guidelines (e.g. lifetime anthracycline dose, age at cancer diagnosis, and history of chest irradiation). Lifetime costs, quality-adjusted life-years, and total risks for heart failure for different screening intervals based on risk profile were compared to no screening. The researchers found that increasing the screening interval could provide similar health benefits at about half the cost of the COG guidelines.
In the second study, researchers used a computer model and a similar hypothetical patient population to compare risks for congestive heart failure (CHF), quality-adjusted life-years, and total costs for different screening intervals. Screening intervals were based on risk for CHF. Persons were categorized as low- or high-risk based on cumulative anthracycline dose. The researchers conclude that less frequent screening may be a more reasonable approach for preventing CHF and is more cost-effective. They suggest that a revision of the current COG guidelines may be warranted.
Study 1: Cost-Effectiveness of the Children's Oncology Group Long-Term Follow-up Screening Guidelines for Childhood Cancer Survivors at Risk for Treatment-Related Heart Failure, F.L. Wong, S. Bhatia, W. Landier, L. Francisco, W. Leisenring, M.M. Hudson, G.T. Armstrong, A. Mertens, M. Stovall, L.L. Robison, G.H. Lyman, S.E. Lipshultz, and S.H. Armenian.
Study 2: Routine Echocardiography Screening for Asymptomatic Left Ventricular Dysfunction in Childhood Cancer Survivors: A Model-Based Estimation of the Clinical and Economic Effects, J.M. Yeh, A. Nohria, and L. Diller.