Abstract 11310: Economic Impact of Increased Longevity in Insertable Cardiac Monitor Technology in Unexplained Syncope and Suspected Atrial Fibrillation Patients

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A11310-A11310
• Main Authors: Witte, Klaus K, Sawyer, Laura M, Bermingham, Sarah L, Rinciog, Claudia, Rosemas, Sarah C, Tsintzos, Stelios I, Reynolds, Matthew R
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.11310

IntroductionThe initial indication for the implantable cardiac monitor (ICM) was unexplained syncope; in this population early use of ICM is recommended following initial nondiagnostic workup. ICMs are also increasingly used for arrhythmia management, with detection of AF in patients with risk factors for subsequent stroke being one of the management indications studied in the cost-effectiveness space. Prolonging the longevity of the device may lead to improved clinical outcomes and positive economic impact by increasing the opportunity for arrhythmia diagnosis and treatment. The objective of this analysis is to compare the cost-effectiveness of a 3-year ICM with a 5-year ICM versus conventional testing in unexplained syncope and suspected AF patients, from a U.S. payer perspective.MethodsEconomic frameworks have been published for both indications. We used these established frameworks to compare the performance of a device with 3 years of battery longevity against a device of 5 years. All other variables remained equal; the incidence of diagnosable events and diagnostic performance of the device were sourced from published clinical trials (e.g. REVEAL AF, EasyAS) and assumed stable for the additional 2 years of follow-up. Patient outcomes and costs were modeled over a lifetime horizon.ResultsIn unexplained syncope, 2 additional years of ICM longevity led to a $1,369 or 30% increase in average per-patient cost savings, primarily driven by a reduction in diagnostic testing and injury costs. Per 1,000 patients, 89 syncopal events and 26 injuries were projected to be avoided. In the suspected AF population, a $5,622 or 19% decrease in the incremental cost per life year was observed, from $28,874 to $23,252 per life year. This was driven by a reduction in embolic stroke events through greater AF detection and treatment. Per 1,000 patients, the increased ICM longevity was predicted to prevent 12 additional stroke events.ConclusionsEnhanced battery longevity leads to a significant improvement in the health economic value of these already highly cost-effective technologies. ICM improves outcomes while cutting costs in syncope patients and delivers better outcomes at a cost thought to represent value-for-money in patients with suspected AF.