Cost–effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke
L. Sawyer, Klaus K. Witte, Matthew R. Reynolds, Suneet Mittal, Frank Grimsey Jones, Sarah Rosemas, Paul Ziegler, Rachelle E. Kaplon, Shadi Yaghi
Abstract
Background: We assessed cost–effectiveness of insertable cardiac monitors (ICMs) in a US cryptogenic stroke population. Materials & methods: We modelled lifetime costs and quality-adjusted life years for three monitoring strategies post cryptogenic stroke: ICM starting immediately, ICM starting after Holter monitoring (delayed ICM) and standard of care involving intermittent ECG and Holter monitoring. Patient characteristics and detection efficacy were based on the CRYSTAL-AF trial. AF detection altered the modelled anticoagulation therapy and subsequent stroke and bleed risks. Results & conclusion: Immediate ICM was found to be cost-effective versus standard of care and cost-saving versus delayed ICM. Results were robust to sensitivity analyses. ICMs are a cost-effective diagnostic tool for the prevention of recurrent stroke in a US cryptogenic stroke population.