OBJECTIVES: Patients who survive a non-ST-elevation myocardial infarction (NSTEMI) are at an elevated risk of future major adverse cardiovascular events (MACE) which could be mitigated through long-term cardiac monitoring. This research aims to explore the cost-effectiveness of remote monitoring (using an ICM) combined with standard of care (SoC) compared to SoC alone.

METHODS: A cost-effectiveness analysis using a lifetime partitioned survival model was developed for a cohort of NSTEMI post-myocardial infarction patients and had a UK NHS and Personal Social Services perspective. Modelled patients also had a CHA₂DS₂-VASc score ≥4 (men) or ≥5 (women) and an LVEF>35%. Survival analysis was used to determine the movement of patients from the pre-MACE health state (where patients could experience arrhythmia, major bleed, systemic embolism) to the post-MACE health state (worsening heart failure, stroke, acute coronary syndrome). Death was possible in all health states. The survival analysis, and arrhythmia diagnoses, were informed from the randomised, parallel, open-label BIO|GUARD-MI trial (NCT02341534). The model captured direct costs associated with each MACE (acute and long-term), implementation and removal of the ICM device, and treatment costs following arrhythmia detection. Disutilities associated with each MACE were also captured.

RESULTS: Over a lifetime time horizon, the use of ICMs for remote monitoring is cost-effective with an incremental cost-effectiveness ratio of £7,915 and a probability of cost-effectiveness of 72% at a threshold of £20,000 per quality-adjusted life year (QALY). The ICM was associated with additional 0.1842 QALYs per patient which outweighed the additional costs of £1,458. The ICM remained cost-effective when model inputs were varied in sensitivity and scenario analyses (deterministic and probabilistic).

CONCLUSIONS: In the UK NHS and Personal Social Services perspective, ICMs with remote monitoring are cost-effective when used in NSTEMI patients post-myocardial infarction.