Key result
Insertable cardiac monitors cut lifetime costs by ~$4500 while adding QALYs versus conventional testing.
Why the study?
ICMs incur higher upfront costs than conventional testing, and the impact of additional diagnoses and resulting treatment on downstream costs and outcomes is unclear.
Does an insertable cardiac monitor improve outcomes and reduce lifetime costs compared to conventional testing in patients with unexplained syncope?
Does an insertable cardiac monitor improve outcomes and reduce lifetime costs compared to conventional testing in patients with unexplained syncope?
Early use of insertable cardiac monitors for unexplained syncope is projected to be cost-saving and improve quality of life compared to conventional testing in the US.
Answers are grounded in this paper and cite their sources.
May inform earlier ICM use in unexplained syncope; extends economic models but leaves open need for prospective confirmation.
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.
No takes yet. Share an insight, caveat, or question.
Sutton et al. (2021) studied Unexplained syncope. Insertable cardiac monitor vs. Conventional testing was evaluated on Quality-adjusted life years (QALYs) and total lifetime costs (savings of US$4532 and 0.30 QALYs gained). Insertable cardiac monitors reduced lifetime costs by US$4532 and led to an average gain of 0.30 quality-adjusted life years compared to conventional testing.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: