OBJECTIVES:  Estimate the short- and long-term financial impact of early referral for ILR (REVEAL®) of Unexplained Syncope patients under the perspective of the Portuguese National Health Service. METHODS: Markov Model to estimate the expected number of Hospital Admissions due to Unexplained Syncope and their financial impact, comparing ILR vs. patients following conventional diagnostic pathways, in a 3 year and lifetime time horizons. A hypothetical cohort of patients with unexplained recurrent syncope, age≥61 years old with similar characteristics to the patient population from the PICTURE trial was modeled. These patients face annually the probability of death, receiving a diagnosis and suffering a recurrent syncope event. Model parameters and transition probabilities were derived from landmark publications. The average cost of a syncope admission was estimated from the latest official Portuguese cost tables and the PICTURE trial. Costs were discounted at 5% p.a. The cost of implanting ILRs was estimated for a total of 215 patients with unexplained syncope, based on the total number of hospitalised syncope patients during one year in Portugal according to the latest National DRG report. PSA was performed to explore the impact of the uncertainty in the input parameters (HR of Death; number of syncope events per year and yield of diagnose) in three year and lifetime time horizons. RESULTS: The average cost of an event was estimated at 1.960€. The total cost of syncope admissions over three years was 66% lower with ILR (501.338€) vs. SoC (1.486.503€). ILR clearly lead to earlier diagnosis and consequently to a lower number of syncope admissions allowing important savings, that in this case were estimated between 985.165€ over three years and 2.177.254€ over patient lifetime. CONCLUSIONS: The utilization of Reveal® leads to less hospital admissions and investigations, proving its potential for significant cost savings in the Portuguese population.