Financial impact of adopting implantable loop recorder diagnostic for unexplained syncope compared with conventional diagnostic pathway in Portugal

Abstract

BackgroundTo 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).MethodsA 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.ResultsThe 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).ConclusionThe 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.

P- and R-Wave Amplitude Sensed By Reveal LINQ™ Loop Recorder in Pediatric Patients

“…2,3 The advantages of this new ILR are its small size and streamlined delivery system, which allows for implantation outside of the cardiac catheterization laboratory. [4][5][6] The Reveal LINQt (Medtronic, Minneapolis, MN) also has an improved algorithm for the detection of both P waves and R waves, which correspond to the signals for atrial and ventricular depolarization, respectively, on the standard electrocardiogram. 7,8 This algorithm has been validated in adult patients to assist in P-wave detection.…”

A Cost-Utility Analysis of the Syncope: Pacing or Recording in The Later Years (SPRITELY) Trial

“…Our work extends this finding, by comparing the ICM to PM insertion, and analyzes a subset of the patients with unexplained syncope included in the model by Providência et al. 32 …”

“…31 The ICM was not part of this model, and model inputs were heavily based on assumptions. 31 In another Markov model by Providência et al., 32 the ICM appeared to result in fewer syncope admissions and cost reductions for patients with unexplained syncope, compared with a conventional diagnostic pathway. Our work extends this finding, by comparing the ICM to PM insertion, and analyzes a subset of the patients with unexplained syncope included in the model by Providência et al.…”

Subcutaneous cardiac rhythm monitors: state of the art review

“…It should be noted these studies were done in France and UK, respectively, where cost and reimbursement structures differ from those in the USA [30]. Other studies have found similar results [31]. Other studies looking at cost per quality-adjusted life (QALY) year have concluded SCRM implantation can be a cost-effective approach in infrequent syncope.…”