Less frequent cardiac screening may be just as effective for monitoring risk in survivors of childhood cancer, according to two analyses of the Childhood Cancer Survivor Study and other data.
F. Lennie Wong, Ph.D., of City of Hope National Medical Center in Duarte, Calif., and colleagues looked at the simulated life histories of 10 million childhood cancer survivors from 5 years after cancer diagnosis until death for each risk profile described in the Children’s Oncology Group (COG) long-term follow-up guidelines. Their findings were published May 19 in the Annals of Internal Medicine.
Dr. F. Lennie Wong
Survivors included children with cancer diagnosed and treated between ages 0 and 20 years, and the simulated population mirrored the Childhood Cancer Survivor Study cohort in terms of sex, age at cancer diagnosis, chest irradiation, and cumulative anthracycline dose (Ann. Intern. Med. 2014;160:672-83).
Lifetime costs and health outcomes (expected life-years, quality adjusted life years, and cumulative incidence of heart failure at 20, 30, and 50 years after cancer diagnosis) achieved by each COG screening schedule based on risk profile, compared with no screening and an incremental cost-effectiveness ratio was calculated for the schedule recommended for each profile.
The base-case analyses examined screening frequencies recommended by the COG guidelines, which researchers found might not be optimal.
"Our results indicate that the costliest – but most effective – strategy was annual screening (incremental cost-effectiveness ratio between $43,100 and $368, 400), and the least expensive was screening every 5 years (between $18,300 and $138,200)," the researchers noted. "Given these observations, we identified the most cost-effective screening frequencies costing less than $100,000 per QALY by reducing annual screening to every 2-4 years depending on risk profile, and biennial screening was reduced to every 5 years."
Reduced frequency screening maintained 80% of the health benefits of the COG guidelines at nearly half the cost, relative to no screening, they noted. Life expectancy was increased 4.9 months (vs. 6.1 months), QALY gain was 0.11 (vs. 0.13), and the reduction in heart failure risk at 30 years after diagnosis was 14.3% (vs. 17.5%).
"When compared with the overall less frequent screening strategy, the COG guidelines had an overall [incremental cost-effectiveness ratio] of $185,300," the investigators said.
In a separate study also published May 19 in the Annals of Internal Medicine, Dr. Jennifer Yeh of Harvard School of Public Health and her associates also examined a cohort of patients who at age 15 years had survived cancer for 5 years (age 10 at diagnosis). All were at risk for asymptomatic left ventricular dysfunction based on treatment with anthracyclines and chest radiation.
They found that cardiac assessment every 10 years had a incremental cost-effectiveness ratio of $111,600 per quality adjusted life year (QALY) gained, compared with no assessment. Assessment every 5 years had an incremental cost-effectiveness ration of $117,900 per QALY gained (Ann. Intern. Med. 2014;160:661-71).
"Incremental cost-effectiveness ratios for more frequent assessments exceeded $165,000 per QALY. [Ratios] for all assessment strategies exceeded $196,000 per QALY gained for the subgroup that received no anthracycline," the researchers noted. "Current recommendations for cardiac assessment may reduce systolic [heart failure] incidence, but less frequent screening than currently recommended may be preferred and possible revision of current recommendations is warranted."
The studies were funded by the National Cancer Institute and the Lance Armstrong Foundation. Dr. Wong and Dr. Yeh reported no relevant conflicts of interest.