Electrocardiographic (ECG) screening of all registered high school and college competitive athletes in the U.S. would cost up to $69 billion over 20 years and would save 4,813 lives, making the cost per life saved more than $10 million, according to a study released Nov. 26 in the Journal of the American College of Cardiology.

The study looked at research from 2006 out of Italy that found that mandatory ECG-based screening of athletes, as required by Italian law, led to a 79 percent relative risk reduction in the incidence of sudden cardiac death.  Building on the 2006 data, this new study imposed a cost-projection model to estimate the annual amount that would be spent in the U.S. on mandatory screenings, cost-per-life saved and number of lives that could be saved.

Additional Resources ACC's Sports and Exercise Cardiology Section and Council

Researchers determined that 8.5 million high school and college athletes would be included annually, reaching 170 million screenings across the 20-year program. This number includes 3.4 million, or 2 percent annual, disqualifications as a result of follow-up screenings. By the last year of the two decade screening program, mortality is estimated to gradually decrease from 4 to .43 per 100,000 athletes and lives saved to increase from 22 per year after year one up to 469 per year by the twentieth year. The cost of two decades of testing is estimated to be between $51 and $69 billion, resulting in 4,813 lives saved at between $10.6 and $14.4 million per life.

The methods of "assessing the benefits of ECG-based pre-participation screening (PPS) in terms of lives per year saved and the costs by pricing the individual diagnostic testing according to Medicate are simplistic and misleading," according to an editorial comment by Antonio Pelliccia, MD, of the Institute of Sport Medicine and Science in Rome. Pelliccia argues that the study overestimates costs because the screenings target young people who are relatively healthy, are done outside of the hospital, and are performed by non-cardiologists. According to the editorial, the PPS fee in Italy is approximately $60 per athlete thanks to a partnership between the Board of Sport Physicians and the Italian federal government. He maintains that obstacles for the U.S. States are not economic, but instead include cultural attitude, medical policy, legal consequences, and awareness of the sports cardiology profession.

"While this research focuses on the monetary costs of mandatory ECG screening, it is important to consider the human costs of false positives, which can result in additional potentially unnecessary tests and removal from play of athletes who are not actually at risk," notes ACC President William Zoghbi, MD, FACC. "Most in this discussion agree that physicals, thorough family histories, targeted testing with ECG and other modalities when needed, widespread training in CPR, and availability of automated external defibrillators save lives from sudden cardiac arrest."

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