Using a simulation model, Yeh et al estimated the cost-effectiveness of routine cardiac assessment—every 1, 2, 5, or 10 years—to detect ALVD and of ACE inhibitor and beta-blocker treatment to reduce CHF incidence in childhood cancer survivors.2 Outcome measures were lifetime risk for systolic CHF, lifetime costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios.

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The investigators found that the lifetime risk for systolic CHF among 5-year childhood cancer survivors aged 15 years was 18.8% without routine cardiac assessment. “Routine echocardiography reduced lifetime risk for CHF by 2.3% (with assessment every 10 years) to 8.7% (annual assessment). The incremental cost-effectiveness ratio for assessment every 10 years was $111,600 per QALY versus no assessment; for every 5 years, it was $117,900 and, for more frequent assessment, exceeded $165,000 per QALY.

“Our findings suggest that current recommendations for cardiac assessment may reduce systolic CHF incidence, but less frequent screening than currently recommended may be preferred and possible revision of current recommendations is warranted,” they wrote.

Yeh et al also noted, “model-based analyses can provide a useful framework to inform policy and practice because randomized, controlled trials to evaluate these guidelines are unlikely to be conducted.”


  1. Steingart RM, Liu JE, Oeffinger KC. Cost-effectiveness of screening for asymptomatic left ventricular dysfunction in childhood cancer survivors. Ann Intern Med. 2014;160(10):731-732.
  2. Yeh JM, Nohria A, Diller L. Routine echocardiography screening for asymptomatic left ventricular dysfunction in childhood cancer survivors: a model-based estimation of the clinical and economic effects. Ann Intern Med. 2014;160(10):661-671.
  3. Wong FL, Bhatia S, Landier W, et al. 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. Ann Intern Med. 2014;160(10):672-683.