Financial impact of adopting implantable loop recorder diagnostic for unexplained syncope compared with conventional diagnostic pathway in Portugal

BMC Cardiovascular Disorders

Research Article

Luís Elvas¹  Rui Providência²  Carlos Morais³  Rui Candeias⁴  Vitor Sanfins⁵  Hipólito Reis⁶  Sara Farinha⁷  Simon Eggington⁸  Stelios Tsintzos⁸ 

[1] Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra, Portugal;Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra, Portugal;Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal;Serviço de Cardiologia, Hospital Geral do, Centro Hospital e Universitário de Coimbra, Quinta dos Vales, 3041-801, S. Martinho do Bispo, Coimbra, Portugal;Hospital Prof. Doutor Fernando da Fonseca EPE, Amadora, Portugal;Hospital de Faro EPE, Faro, Portugal;Hospital de Guimarães, Centro Hospitalar do Alto Ave EPE, Guimarães, Portugal;Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal;Medtronic, Lisboa, Portugal;Medtronic, Tolochenaz, Switzerland;

关键词: Syncope;    Implantable loop recorder;    Emergency department;    Budget impact analysis;   

DOI  :  10.1186/1471-2261-14-63

 received in 2013-08-30, accepted in 2014-04-28,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundTo estimate the short- and long-term financial impact of early referral for implantable loop recorder diagnostic (ILR) versus conventional diagnostic pathway (CDP) in the management of unexplained syncope (US) in the Portuguese National Health Service (PNHS).MethodsA Markov model was developed to estimate the expected number of hospital admissions due to US and its respective financial impact in patients implanted with ILR versus CDP. The average cost of a syncope episode admission was estimated based on Portuguese cost data and landmark papers. The financial impact of ILR adoption was estimated for a total of 197 patients with US, based on the number of syncope admissions per year in the PNHS. Sensitivity analysis was performed to take into account the effect of uncertainty in the input parameters (hazard ratio of death; number of syncope events per year; probabilities and unit costs of each diagnostic test; probability of trauma and yield of diagnosis) over three-year and lifetime horizons.ResultsThe average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Over a lifetime horizon, the total discounted costs of hospital admissions and syncope diagnosis for the entire cohort were 23% lower amongst patients in the ILR group compared with the CDP group (1,204,621€ for ILR, versus 1,571,332€ for CDP).ConclusionThe utilization 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. The result is robust to changes in the input parameter values, and cost savings become more pronounced over time.

【 授权许可】

CC BY   
© Providência et al.; licensee BioMed Central Ltd. 2014