BUDGET IMPACT OF CONTINUOUS AMBULATORY ECG MONITORING: A REAL-WORLD DATA MODEL
Author(s)
Pierantonio Russo, MD1, Ramaa Nathan, PhD1, Daniel Pfeffer, PhD1, Wei Jie, Jason Poh, PhD1, Harjeet Singh, MBA1, Ken Boyle, DC, MBA, HEOR-C2, Erik M. Hendrickson, MA, MPH, PhD2, Brent Wright, DrPH, MBA, RN, PHN2;
1Eversana, Overland Park, KS, USA, 2iRhythm Technologies, San Francisco, CA, USA
1Eversana, Overland Park, KS, USA, 2iRhythm Technologies, San Francisco, CA, USA
OBJECTIVES: Cost-effectiveness does not ensure affordability, underscoring the importance of budget impact assessment for payors in coverage decisions. This limitation is evident in early arrhythmia detection using ambulatory cardiac monitoring (ACM), where the budget impact relative to no monitoring remains unclear. Because most budget impact models (BIM) are literature-based and may not reflect real utilization and costs, we developed a BIM using real-world data (RWD) to estimate the financial impact of ACM adoption in patients at risk for arrhythmia.
METHODS: Administrative claims (2018-2025) were analyzed to identify patients with major arrhythmias (AF/AFL, AVB, VT, SVT, long QT) and risk factors (obesity, hypertension, CVD, T2D, CKD, COPD, MACE). ACM-monitored patients were compared with non-monitored patients. Estimates of 90-day diagnostic yield (DY), healthcare resource utilization, and setting-specific costs were generated. The target population was projected nationally using census-adjusted prevalence and incidence models. Sensitivity analyses were conducted via a dynamic dashboard varying demographic, clinical and cost estimates.
RESULTS: Among 20M patients with a major arrhythmia, 74% had two or more prior risk factors. Of 650K monitored patients, 85% were monitored once (14 days), with DY of 92% for any arrhythmia and 55% for major arrhythmias. Monitored patients incurred lower mean arrhythmia-related ED costs per visit ($9,206 vs $12,755), fewer ED-to-inpatient transfers (28% vs 35%), and lower mean hospitalization costs per episode ($25,979 vs $31,420) than non-monitored patients. After accounting for monitoring costs, the projected budget impact was favorable for the ACM monitored cohort, with savings ranging from $12 PPPM among patients with any risk factor to more than $100 PPPM among patients with multiple major risk factors.
CONCLUSIONS: Payors and ACOs must assess the net financial impact of adding ACM under different adoption scenarios. Our BIM shows that arrhythmias detection in ambulatory settings can offset monitoring costs by reducing acute care services, for selected at-risk patients.
METHODS: Administrative claims (2018-2025) were analyzed to identify patients with major arrhythmias (AF/AFL, AVB, VT, SVT, long QT) and risk factors (obesity, hypertension, CVD, T2D, CKD, COPD, MACE). ACM-monitored patients were compared with non-monitored patients. Estimates of 90-day diagnostic yield (DY), healthcare resource utilization, and setting-specific costs were generated. The target population was projected nationally using census-adjusted prevalence and incidence models. Sensitivity analyses were conducted via a dynamic dashboard varying demographic, clinical and cost estimates.
RESULTS: Among 20M patients with a major arrhythmia, 74% had two or more prior risk factors. Of 650K monitored patients, 85% were monitored once (14 days), with DY of 92% for any arrhythmia and 55% for major arrhythmias. Monitored patients incurred lower mean arrhythmia-related ED costs per visit ($9,206 vs $12,755), fewer ED-to-inpatient transfers (28% vs 35%), and lower mean hospitalization costs per episode ($25,979 vs $31,420) than non-monitored patients. After accounting for monitoring costs, the projected budget impact was favorable for the ACM monitored cohort, with savings ranging from $12 PPPM among patients with any risk factor to more than $100 PPPM among patients with multiple major risk factors.
CONCLUSIONS: Payors and ACOs must assess the net financial impact of adding ACM under different adoption scenarios. Our BIM shows that arrhythmias detection in ambulatory settings can offset monitoring costs by reducing acute care services, for selected at-risk patients.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE5
Topic
Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)