Economic value of insertable cardiac monitors in unexplained syncope in the United States.

Autor:	Sutton BS; University of Louisville, Louisville, Kentucky, USA., Bermingham SL; Symmetron Ltd, London, UK., Diamantopoulos A; Symmetron Ltd, London, UK., Rosemas SC; Medtronic Inc, Minneapolis, Minnesota, USA sarah.c.rosemas@medtronic.com., Tsintzos SI; Health Economics and Reimbursement, Medtronic Europe SA, Tolochenaz, Vaud, Switzerland., Xia Y; Medtronic Inc, Minneapolis, Minnesota, USA., Reynolds MR; Cardiovascular Medicine, Baim Institute for Clinical Research, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Open heart [Open Heart] 2021 Feb; Vol. 8 (1).
DOI:	10.1136/openhrt-2020-001263
Abstrakt:	Introduction: Early use of insertable cardiac monitor (ICM) is recommended for patients with unexplained syncope following initial clinical workup, due to its superior ability to establish symptom-rhythm correlation compared with conventional testing (CONV). However, ICMs incur higher upfront costs, and the impact of additional diagnoses and resulting treatment on downstream costs and outcomes is unclear. We aimed to evaluate the cost-effectiveness of ICM compared with CONV for the diagnosis of arrhythmia in patients with unexplained syncope, from a US payer perspective. Methods: A Markov model was developed to estimate lifetime costs and benefits of arrhythmia diagnosis with ICM versus CONV, considering all related diagnostic and arrhythmia-related treatment costs and consequences. Cohort characteristics and costs were informed by original claims database analyses. Risks of mortality, syncopal recurrence, injury due to syncope and quality of life consequences from syncopal events were identified from the literature. Results: ICM was less costly and more effective than CONV. Most of the observed US$4532 cost savings were attributed to reduced downstream diagnostic testing. For every 1000 patients, ICM was projected to yield an additional 253 arrhythmia diagnoses and lead to treatment in an additional 168 patients. The ICM strategy resulted in overall improved outcomes (0.30 quality-adjusted life years gained), due to a reduction in syncope recurrence and injury resulting from arrhythmia treatment. The results were robust to changes in the base case parameters but sensitive to the model time horizon, underlying probability of syncope recurrence and prevalence of arrhythmias. Conclusions: Our model projected that early ICM for the diagnosis of unexplained syncope reduced long-term costs, and led to an improvement in overall clinical outcomes by shortening time to arrhythmia treatment. The cost of ICM was outweighed by savings arising from fewer downstream diagnostic episodes, and the increased cost of treatment was counterbalanced by fewer syncope-related event costs. Competing Interests: Competing interests: SR and AD are employed by Symmetron Ltd, which received funding from Medtronic plc for this analysis. BS and MR have received consultancy fees from Medtronic plc. SR, ST and YX are employees and have equity interest in Medtronic plc. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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