All-cause healthcare cost differences across ambulatory cardiac monitoring modalities in Medicare beneficiaries: a real-world claims-based study using entropy balancing

Objectives Arrhythmias, including atrial fibrillation and ventricular tachycardia, are associated with substantial morbidity and healthcare utilization in older adults. Ambulatory cardiac monitoring (ACM) is used to evaluate suspected or known arrhythmias; however, monitoring modalities vary in duration, diagnostic yield, and cost. We evaluated differences in total cost of care across major ACM modalities using real-world Medicare claims data.Methods We conducted a retrospective cohort analysis using the Merative MarketScan Medicare Claims Database to estimate per patient per month (PPPM) costs in the 12 months following initiation of one of four ACM modalities among Medicare beneficiaries newly monitored between 2016 and 2024. The analytic cohort included 132,082 beneficiaries: Holter (n = 70,799), long-term continuous monitoring (LTCM, n = 25,294), mobile cardiac telemetry (MCT, n = 20,085), and external ambulatory event monitoring (AEM, n = 15,904). Entropy balancing was applied to align baseline covariates. Weighted mean PPPM costs and Tukey-adjusted pairwise cost differences were estimated using weighted regression models.Results Holter monitors accounted for the largest share of index monitoring, while LTCM utilization increased substantially over the study period. Weighted PPPM costs were lowest for LTCM ($2,678), followed by AEM ($2,721), Holter ($2,873), and MCT ($3,034) (overall p < .001). In pairwise comparisons, Holter and MCT had significantly higher weighted PPPM costs than LTCM, with absolute differences of $196 (p = .002) and $357 (p < .001), respectively. AEM had numerically higher weighted PPPM costs than LTCM ($44; p = .938).Conclusion Among Medicare beneficiaries, LTCM was associated with lower weighted 12-month total costs of care compared with Holter and MCT.