THE ECONOMIC BURDEN OF SYNCOPE AND SPECIALIST UNIT COSTS: A UK SCENARIO AND BREAK-EVEN ANALYSIS
Author(s)
Cristiana Monteiro, MSc1, Nigel Eric Breakwell, BSc2, Trudie Lobban, MBE FCRP3, Mehran Asgari, MD4, Richard Sutton, MB BS DSc FRCP5.
1London, United Kingdom, 2DOT I/O HEALTH, South Woodford, United Kingdom, 3STARS, Stratford Upon Avon, United Kingdom, 4STARS, London, United Kingdom, 5Imperial College London, London, United Kingdom.
1London, United Kingdom, 2DOT I/O HEALTH, South Woodford, United Kingdom, 3STARS, Stratford Upon Avon, United Kingdom, 4STARS, London, United Kingdom, 5Imperial College London, London, United Kingdom.
OBJECTIVES: To estimate the annual economic burden of syncope in the United Kingdom and assess the unit cost and break-even conditions for a guideline-aligned specialist syncope unit (SU).
METHODS: Cost-of-illness, micro-costing and scenario analysis in GBP from NHS and societal perspectives. Hospital activity was derived from Freedom of Information returns covering the three years preceding data collection in 2025 from all NHS Trusts in the UK, with a 92.5% response rate. Three-year activity was annualised and extrapolated to estimate national yearly utilisation and costs. FOI data were supplemented by published evidence on healthcare utilisation and productivity losses. Direct healthcare costs were valued using NHS Payment Scheme benchmarks, while productivity losses were estimated using a human-capital approach. A guideline-aligned specialist syncope unit pathway was micro-costed using staff time, appointments, investigations and literature-derived test utilisation. Because comparative effectiveness data were unavailable, potential savings were examined as scenarios rather than treated as observed causal effects.
RESULTS: A preliminary literature-based scenario estimated annual costs of £474.5 million. An FOI-coded upper-bound scenario estimated £1.45 billion, comprising direct healthcare costs and productivity losses. The weighted SU pathway cost was £871 per assessed patient. Against the modelled baseline societal cost of £1,329 per eligible patient, complete substitution of baseline costs produced a maximum theoretical saving of £458 per patient. Cost neutrality required displacement of at least 65.5% of baseline costs. Key uncertainties were the case definition, unique-patient denominator, attribution of ED observation, employment exposure and SU effectiveness.
CONCLUSIONS: Syncope imposes a substantial economic burden. Our model identifies conditions under which structured SUs could be economically attractive and supports prospective comparative evaluation using standardised resource-use, diagnostic, re-attendance, admission, productivity and quality-of-life outcomes.
METHODS: Cost-of-illness, micro-costing and scenario analysis in GBP from NHS and societal perspectives. Hospital activity was derived from Freedom of Information returns covering the three years preceding data collection in 2025 from all NHS Trusts in the UK, with a 92.5% response rate. Three-year activity was annualised and extrapolated to estimate national yearly utilisation and costs. FOI data were supplemented by published evidence on healthcare utilisation and productivity losses. Direct healthcare costs were valued using NHS Payment Scheme benchmarks, while productivity losses were estimated using a human-capital approach. A guideline-aligned specialist syncope unit pathway was micro-costed using staff time, appointments, investigations and literature-derived test utilisation. Because comparative effectiveness data were unavailable, potential savings were examined as scenarios rather than treated as observed causal effects.
RESULTS: A preliminary literature-based scenario estimated annual costs of £474.5 million. An FOI-coded upper-bound scenario estimated £1.45 billion, comprising direct healthcare costs and productivity losses. The weighted SU pathway cost was £871 per assessed patient. Against the modelled baseline societal cost of £1,329 per eligible patient, complete substitution of baseline costs produced a maximum theoretical saving of £458 per patient. Cost neutrality required displacement of at least 65.5% of baseline costs. Key uncertainties were the case definition, unique-patient denominator, attribution of ED observation, employment exposure and SU effectiveness.
CONCLUSIONS: Syncope imposes a substantial economic burden. Our model identifies conditions under which structured SUs could be economically attractive and supports prospective comparative evaluation using standardised resource-use, diagnostic, re-attendance, admission, productivity and quality-of-life outcomes.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE463
Topic
Economic Evaluation, Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas