When each device is compared incrementally , BioMonitor 2-AF dominates Reveal LINQ and Confirm RX .
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after st and ard diagnostic tests .
Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants .
OBJECTIVES The objectives were to assess the diagnostic test accuracy , clinical effectiveness and cost-effectiveness of three implantable monitors [ BioMonitor 2-AF ™ ( Biotronik SE & Co. KG , Berlin , Germany ) , Confirm Rx ™ ( Abbott Laboratories , Lake Bluff , IL , USA ) and Reveal LINQ ™ ( Medtronic plc , Minneapolis , MN , USA ) ] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring .
Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in patients with cryptogenic stroke
Background and aims 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 st and ard of care . Methods 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 r and omized 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 % . Results Monitoring cryptogenic stroke patients with an insertable cardiac monitor was associated with fewer recurrent strokes and increased quality -adjusted life years compared to the st and ard of care ( 7.37 vs 7.22 ) . Stroke-related costs were reduced in insertable cardiac monitor patients , but overall costs remained higher than the st and ard of care ( £ 19,631 vs £ 17,045 ) . The incremental cost-effectiveness ratio was £ 17,175 per quality -adjusted life years gained , compared to st and ard 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 . Conclusion 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
When each device is compared incrementally , BioMonitor 2-AF dominates Reveal LINQ and Confirm RX .
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after st and ard diagnostic tests .
Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants .
OBJECTIVES The objectives were to assess the diagnostic test accuracy , clinical effectiveness and cost-effectiveness of three implantable monitors [ BioMonitor 2-AF ™ ( Biotronik SE & Co. KG , Berlin , Germany ) , Confirm Rx ™ ( Abbott Laboratories , Lake Bluff , IL , USA ) and Reveal LINQ ™ ( Medtronic plc , Minneapolis , MN , USA ) ] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring .