OBJECTIVES: Physicians faced with the challenge of syncope diagnosis usually depend on a series of repeated tests to identify the cause of syncope or transient loss of consciousness (T-LOC) events. In addition to ECGs, Tilt Tests, EP Studies and Holter Monitors, physicians now have the option to also include implantable loop recorders (ILRs) in their diagnostic pathway. Given the high burden of syncope diagnostics on hospital resources, there is increasing attention on the use of ILRs given their higher diagnostic capabilities and potential to decrease the burden of multiple and repeated tests.  We sought to examine the potential cost-effectiveness of adding an ILR to the traditional clinical pathway. We developed a decision-analytic model, comparing the cost per diagnosis of standard diagnostics with that of standard diagnosis plus the ILR. METHODS: Decision-Analytic Model in Microsoft Excel; Literature Reviews for diagnostic yields of ECGs, Holter Monitors, Cardiac Ultrasounds, Tilt Tests, EP Studies and Standard Evaluations; Cost Data based on Prislista Södra Regionvårdsnämnden, Lund, Sweden. RESULTS: The ILR-base strategy was observed to significantly increase the rate of diagnosis in an unselected population with recurrent syncope:  33% of patients receiving an ECG-confirmed diagnosis compared to 4% in the conventional care group. There was also a significant decrease in the rates of hospitalisation and investigation in patients receiving the ILR.  The total cost of testing per patient in the ILR-based pathway was higher than that in the conventional pathway, however the cost per diagnosis achieved was lower in the ILR pathway given the significantly higher diagnostic power of the implanted device.  The incremental cost per correct diagnosis was 12,930 SEK.  This figure accounts for the differences in total costs and diagnostic efficacy between the ILR-based and conventional pathways.  Results form probabalistic sensitivity analysis suggest a 95% upper bound of 35,305 SEK and a lower bound dominated by the ILR-based strategy.  Simulations across the cost-effectiveness plane suggest an approximately 7% probability that the ILR-based strategy is both more effective and less costly.  CONCLUSIONS: ILRs have been shown to exhibit diagnostic superiority when compared to conventional testing.  In this analysis, we observe lower cost per correct diagnosis and an acceptable incremental cost per diagnosis when compared to typical costs of syncope hospitalizations in Sweden.  ILRs are a cost-effective means of achieving a diagnosis in patients suffering from recurrent unexplained syncope.  Further work could incorporate HRQoL benefits because of reduced time-to-diagnosis and faster access to treatment. Faster access to care may also demonstrate cost-savings by preventing death, falls and fractures while patients remain without treatment.