December 06, 2020
For detecting occult atrial fibrillation in patients with cryptogenic stroke, 3-year implantable loop recorder monitoring has a cost per quality-adjusted life-year (QALY) gained in the range of other publicly funded therapies, according to a study published online in the International Journal of Stroke.
“Timely identification of occult atrial fibrillation following cryptogenic stroke facilitates consideration of oral anticoagulation therapy,” researchers wrote in the study background. “Extended electrocardiography monitoring beyond 24 to 48 h Holter monitoring improves atrial fibrillation detection rates, yet uncertainty remains due to upfront costs and the projected long-term benefit.”
For the study, researchers modeled the cost-effectiveness of three electrocardiograph monitoring strategies after cryptogenic stroke: 30-day electrocardiography monitoring, 3-year implantable loop recorder monitoring, and conventional Holter monitoring.
For conventional monitoring, lifetime discounted costs and QALYs were $206,385 and 7.77 QALYs. For 30-day electrocardiography monitoring, they were $207,080 and 7.79 QALYs. For the implantable loop recorder strategy, they were $210,728 and 7.88 QALYs, researchers reported.
“Additional QALYs could be attained at a more favorable incremental cost per QALY with the implantable loop recorder strategy, compared with the 30-day electrocardiography monitoring strategy, thereby eliminating the 30-day strategy by extended dominance,” they advised.
Compared with conventional modeling, 3-year implantable loop recorder monitoring was linked with an incremental cost per QALY gained of $40,796, according to the study.
“The value proposition is improved when considering patients at the highest risk of recurrent ischemic stroke,” researchers wrote. “However, the implantable loop recorder strategy is associated with increased health care costs, and the opportunity cost of widescale implementation must be considered.”
Chew DS, Rennert-May E, Quinn FR, et al. Economic evaluation of extended electrocardiogram monitoring for atrial fibrillation in patients with cryptogenic stroke [published online ahead of print, 2020 Nov 24]. Int J Stroke. 2020;1747493020974561. doi:10.1177/1747493020974561