OBJECTIVES: Syncope is a significant burden on the healthcare system and individuals. Screening manoeuvres including medical examination, ambulatory external monitoring, imaging and clinical diagnostic tests provide a presumptive diagnosis in a limited number of patients since syncope recurrence is unpredictable. Establishing or ruling out a cardiac arrhythmia as the cause is challenging, time consuming and relies on recording the cardiac rhythm at the time of spontaneous recurrences. The Insertable Cardiac Monitor(ICM) is a new, efficient and accurate technique for long-term monitoring and recording the “events” in a patient. This study assesses the cost-effectiveness of adding the ICM to the standard diagnostic protocol in Canadian healthcare system. METHODS: A decision analytic model was developed assessing the cost-effectiveness of the standard diagnosis approach compared to ICM from a Canadian provider perspective. The main clinical outcome used in the model was “yield” defined as the rate of correct diagnoses derived from published literature. The frequency of resources used and associated costs were derived from literature and the Ontario Health Insurance Policy. RESULTS: The diagnosis yield for ICM and standard approach was 33.7% and 4.1% respectively. The model assessed the cost per diagnosis in the two arms. The incremental cost per diagnosis was $6237 in favour of ICM. Sensitivity analysis showed that in the lower confidence interval (CI) the ICM is the “dominant” option and in upper CI limits the ICER was $35,358 and below the $50,000 acceptability threshold. CONCLUSIONS: ICM is a safe, accurate and effective device for diagnosis of syncope and should be considered as an alternative in diagnosis of syncope. The cost of ICM is partially offset by savings in hospitalization. A societal perspective will reduce the ICER in favour of ICM by preventing complications of syncope (i.e., falls, fractures, mortality) and increase patient HRQoL.