Insertable cardiac monitor for atrial fibrillation detection likely cost-effective in US
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Key takeaways:
- Insertable cardiac monitoring was estimated to be cost-effective for AF detection in the U.S.
- This finding was mainly driven by increased guideline-recommended oral anticoagulation and fewer lifetime strokes.
Insertable cardiac monitoring for atrial fibrillation detection was found to be cost-effective, especially among high-risk patients, according to an economic analysis of the STROKE AF trial presented at the International Stroke Conference.
“In a model that assumes that risk of stroke derived from prior studies of AF is applicable to patients with [insertable cardiac monitor]-detected AF, use of [insertable cardiac monitor] as an initial strategy is more cost-effective than usual rhythm monitoring care over a lifetime horizon. This is due to more frequent AF detection with greater and earlier opportunities to initiate anticoagulation to prevent future AF-related secondary strokes,” Lee H. Schwamm, MD, associate dean for digital strategy and transformation at Yale School of Medicine and senior vice president and chief digital health officer for Yale New Haven Health System, said in a press release issued by Medtronic.
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STROKE AF was a prospective, randomized, multicenter trial that enrolled 492 patients (mean age, 67 years; 62% men) with ischemic stroke, no prior AF diagnosis and large artery or small vessel disease. Participants were randomly assigned to continuous monitoring with an insertable cardiac monitor (Reveal LINQ, Medtronic) or a control group who received standard-of-care AF detection.
As Healio previously reported, the 12-month rate of new detected AF was 12.1% in the insertable cardiac monitor group compared with 1.8% in the control group.
For the present study, Schwamm and colleagues developed a lifetime Markov model to estimate the cost-effectiveness of insertable cardiac monitors compared with standard care to detect new AF among STROKE AF participants.
For the analysis, AF detection was assumed to result in a switch from aspirin to guideline-recommended oral anticoagulation, unless precluded by prior bleeding events.
The researchers reported that use of an insertable cardiac monitor was associated with 0.17 more quality-adjusted life-years compared with standard care. Subsequent increased oral anticoagulant use was estimated to result in 53 fewer strokes projected per 1,000 patients, according to the study.
High cost-effectiveness in the U.S. was defined as less than $50,000 per QALY gained.
Total lifetime per-patient costs were estimated to be $65,989 with continuous monitoring via insertable cardiac monitor and $59,703 with standard care.
The incremental cost-effectiveness ratio of insertable cardiac monitoring was estimated to be $37,760 per QALY gained; it was even more favorable in patients with a CHA2DS2-VASc score of 6 or more. Among patients at high risk for AF detection, such as those with left atrial enlargement, HF, obesity or prolonged QRS, cost-effectiveness was further improved to $22,016 per QALY.
“This economic value analysis demonstrates [insertable cardiac monitors] may be a highly cost-effective strategy for the prevention of recurrent stroke in patients with large artery and small vessel disease, with results similar to the cost analysis findings in the landmark CRYSTAL-AF study of cryptogenic stroke patients,” Schwamm said in the release.
Reference:
- Medtronic LINQ Insertable Cardiac Monitors prove cost-effective compared to standard of care in ischemic stroke patients with suspected atrial fibrillation. https://news.medtronic.com/Medtronic-LINQ-Insertable-Cardiac-Monitors-prove-cost-effective-compared-to-standard-of-care-in-ischemic-stroke-patients-with-suspected-atrial-fibrillation. Published Feb. 7, 2024. Accessed Feb. 13, 2024.
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Yaghi S, et al. Abstract 138. Presented at: International Stroke Conference; Feb. 7-9, 2024; Phoenix.
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