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Title: Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke.
Austin Authors: Diamantopoulos, Alex;Sawyer, Laura M;Lip, Gregory Y H;Witte, Klaus K;Reynolds, Matthew R;Fauchier, Laurent;Thijs, Vincent;Brown, Ben;Quiroz Angulo, Maria E;Diener, Hans-Christoph
Affiliation: Symmetron Limited, Kinetic Centre, Elstree, London, UK
University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK
Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
Lahey Hospital & Medical Center, Burlington, MA, USA
Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
Economics and Quality of Life Research, Harvard Clinical Research Institute, Boston, MA, USA
Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Université François Rabelais, Tours, France
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Medtronic, Tolochenaz, Switzerland
Medtronic, Mounds View, MN, USA
Department of Neurology and Stroke Center, University Hospital Essen, Germany
Issue Date: Apr-2016
Date: 2016-01-06
Publication information: International Journal of Stroke 2016; 11(3): 302-12
Abstract: Documentation of atrial fibrillation is required to initiate oral anticoagulation therapy for recurrent stroke prevention. Atrial fibrillation often goes undetected with traditional electrocardiogram monitoring techniques. We evaluated whether atrial fibrillation detection using continuous long-term monitoring with an insertable cardiac monitor is cost-effective for preventing recurrent stroke in patients with cryptogenic stroke, in comparison to the standard of care. A lifetime Markov model was developed to estimate the cost-effectiveness of insertable cardiac monitors from a UK National Health Service perspective using data from the randomized CRYSTAL-AF trial and other published literature. We also conducted scenario analyses (CHADS2 score) and probabilistic sensitivity analyses. All costs and benefits were discounted at 3.5%. Monitoring cryptogenic stroke patients with an insertable cardiac monitor was associated with fewer recurrent strokes and increased quality-adjusted life years compared to the standard of care (7.37 vs 7.22). Stroke-related costs were reduced in insertable cardiac monitor patients, but overall costs remained higher than the standard of care (£19,631 vs £17,045). The incremental cost-effectiveness ratio was £17,175 per quality-adjusted life years gained, compared to standard of care in the base-case scenario, which is below established quality-adjusted life years willingness-to-pay thresholds. When warfarin replaced non-vitamin-K oral anticoagulants as the main anticoagulation therapy, the incremental cost-effectiveness ratio was £13,296 per quality-adjusted life years gained. Insertable cardiac monitors are a cost-effective diagnostic tool for the prevention of recurrent stroke in patients with cryptogenic stroke. The cost-effectiveness results have relevance for the UK and across value-based healthcare systems that assess costs relative to outcomes.
DOI: 10.1177/1747493015620803
ORCID: 0000-0002-6614-8417
Journal: International Journal of Stroke
PubMed URL: 26763916
Type: Journal Article
Subjects: Atrial fibrillation
cost-effectiveness analysis
Cryptogenic Stroke
insertable cardiac monitor
oral anticoagulation therapy
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