Although sudden cardiac death (SCD) is an uncommon event in children, when it occurs, one always wonders whether it could have been prevented. To test whether a targeted screening program for SCD would be cost-effective and therefore feasible to implement, researchers designed simulation models for two populations of children at highest risk for SCD: those ages 6 to 11 years who start stimulant medications for the management of attention deficit-hyperactivity disorder (ADHD) and high school-age adolescents engaged in organized sports.

The models considered the costs of screening, which would initially involve a history, physical examination, and electrocardiogram (ECG), and if a positive result was found, the subsequent diagnostic tests and clinical management of the detected disease. Algorithms were created around three cardiac conditions that are associated with SCD and detectable on ECG: hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, and long-QT syndrome. The outcomes evaluated were cost and lost life-years caused by death from one of these cardiac conditions.

The generally accepted standard of a life-saving treatment's cost-effectiveness is a cost of between $50,000 and $100,000 per life-year gained. The results from the model analysis showed that screening school-age children prior to the initiation of ADHD medication would cost approximately $204,000 per life-year gained, rendering it not cost-effective. Screening adolescents prior to sports participation would cost approximately $91,000 for each life-year gained, which is at the high end of cost-effectiveness. The large cost differential between the two groups may be explained by the much higher yield of positive cases of hypertrophic cardiomyopathy found in adolescents than in younger children resulting from the comparative lateness of the disease's phenotypic expression. The number of SCD cases prevented per individual screened was 3.6 x 10^-5 (0.000036) in the younger ADHD group and 7.5 x 10^-5 (0.000075) in the adolescent sports group. Life expectancy was predicted to rise by 0.8 to 1.6 days per person screened. The authors concluded that the low prevalence of SCD, along with the high cost of screening at-risk children, ultimately didn't support adoption of widespread screening for SCD.

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