Table .1 Characteristics of the costing studies of AECG Study ID Population Intervention Derivation of costs Cost findings Conclusions Country Unexplained syncope Average cost of a syncope event was Providencia Patients with Early referral Data on the frequency of use of a The utilisation of ILR leads to an earlier diagnosis and (2014) unexplained, for ILR vs range of diagnostic tests came from estimated to be between and lower number of syncope hospital admissions and 1,760€ recurrent syncope conventional the published literature and was used investigations, thus allowing significant cost offsets in 2,800€. Portugal (N=197). diagnostic to estimate the average cost of Lifetime horizon costs (discounted) of the Portuguese setting. pathway syncope episode admissions, using hospital admissions and syncope diagnosis Healthcare ILR appears to be significantly cost saving over a (CDP). costs from the PNHS prices table for the entire cohort were 23% lower system lifetime horizon under every scenario considered. (2013).a among patients in the ILR group compared (PNHS) sensitivity analyses failed to identify any plausible with the CDP group for ILR (1,204,621€ Two DRG tariffs were used as a scenario under which ILR use does not result in vs for CDP). 1,571,332€ proxy for the (inpatient) cost of significant cost savings, prompting us to believe that This translates to a saving of per 1,861€ trauma/injury in recurrent syncope. ILRs should be offered to indicated patients. patient. ILR device cost was based (2,000€) ILR led to an earlier diagnosis and on the price of Reveal DX loop consequently to a lower number of recorder in Portugal. syncope hospital admissions, allowing A Markov model was developed to important hospital offsets, with savings of estimate the expected number of between and for the 307,872€ 973,429€ hospital admissions due to entire cohort to per patient) (1,563€ 4,941€ unexplained syncope and its over a lifetime horizon. respective financial impact in patients Over a 3-year horizon, costs were higher in implanted with ILR vs CDP. the ILR group, due to the upfront cost of the device and implantation. Time horizon: 3 yrs and lifetime. Costs discounted at 5% per yr.
Table .1 Characteristics of the costing studies of AECG Study ID Country Population Intervention Derivation of costs Cost findings Conclusions Unexplained syncope Providencia (2014) Portugal Healthcare system (PNHS) Patients with unexplained, recurrent syncope (N=197). Early referral for ILR vs conventional diagnostic pathway (CDP). Data on the frequency of use of a range of diagnostic tests came from the published literature and was used to estimate the average cost of syncope episode admissions, using costs from the PNHS prices table (2013).a Two DRG tariffs were used as a proxy for the (inpatient) cost of trauma/injury in recurrent syncope. ILR device cost (2,000€) was based on the price of Reveal DX loop recorder in Portugal. A Markov model was developed to estimate the expected number of hospital admissions due to unexplained syncope and its respective financial impact in patients implanted with ILR vs CDP. Time horizon: 3 yrs and lifetime. Costs discounted at 5% per yr. Average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Lifetime horizon costs (discounted) of hospital admissions and syncope diagnosis for the entire cohort were 23% lower among patients in the ILR group compared with the CDP group (1,204,621€ for ILR vs 1,571,332€ for CDP). This translates to a saving of 1,861€ per patient. ILR led to an earlier diagnosis and consequently to a lower number of syncope hospital admissions, allowing important hospital offsets, with savings of between 307,872€ and 973,429€ for the entire cohort (1,563€ to 4,941€ per patient) over a lifetime horizon. Over a 3-year horizon, costs were higher in the ILR group, due to the upfront cost of the device and implantation. The utilisation 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. ILR appears to be significantly cost saving over a lifetime horizon under every scenario considered. sensitivity analyses failed to identify any plausible scenario under which ILR use does not result in significant cost savings, prompting us to believe that ILRs should be offered to indicated patients.
AECGReviewReport.docx