Key result
ILRs cut lifetime hospital and diagnostic costs ~23% vs conventional pathways in unexplained syncope.
Why the study?
Does early referral for implantable loop recorder diagnostic reduce hospital admissions and costs in patients with unexplained syncope?
Does early referral for implantable loop recorder diagnostic reduce hospital admissions and costs in patients with unexplained syncope?
Effect estimate: 23% lower
Absolute Event Rate: 1204621% vs 1571332%
The utilization of implantable loop recorders for unexplained syncope leads to earlier diagnosis and fewer hospital admissions, resulting in significant long-term cost savings in the Portuguese healthcare setting.
May support ILR cost savings in unexplained syncope; extends economic models but leaves open randomized confirmation.
BACKGROUND: To estimate the short- and long-term financial impact of early referral for implantable loop recorder diagnostic (ILR) versus conventional diagnostic pathway (CDP) in the management of unexplained syncope (US) in the Portuguese National Health Service (PNHS). METHODS: A Markov model was developed to estimate the expected number of hospital admissions due to US and its respective financial impact in patients implanted with ILR versus CDP. The average cost of a syncope episode admission was estimated based on Portuguese cost data and landmark papers. The financial impact of ILR adoption was estimated for a total of 197 patients with US, based on the number of syncope admissions per year in the PNHS. Sensitivity analysis was performed to take into account the effect of uncertainty in the input parameters (hazard ratio of death; number of syncope events per year; probabilities and unit costs of each diagnostic test; probability of trauma and yield of diagnosis) over three-year and lifetime horizons. RESULTS: The average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Over a lifetime horizon, the total discounted costs of hospital admissions and syncope diagnosis for the entire cohort were 23% lower amongst patients in the ILR group compared with the CDP group (1,204,621€ for ILR, versus 1,571,332€ for CDP). CONCLUSION: The utilization of ILR leads to an earlier diagnosis and lower number of syncope hospital admissions and investigations, thus allowing significant cost offsets in the Portuguese setting. The result is robust to changes in the input parameter values, and cost savings become more pronounced over time.
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Providência et al. (2014) studied Unexplained syncope (n=394). Implantable loop recorder (ILR) vs. Conventional diagnostic pathway (CDP) was evaluated on Total discounted costs of hospital admissions and syncope diagnosis over a lifetime horizon (in Euros) (23% lower). Implantable loop recorders reduced total lifetime costs of hospital admissions and syncope diagnosis by 23% compared with a conventional diagnostic pathway in patients with unexplained syncope.
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