OBJECTIVES: The effectiveness of Insertable Cardiac Monitors (ICMs – also referred to as implantable loop recorders in the past) in detecting arrhythmia in syncope patients is well established in the literature. This analysis evaluates the cost-effectiveness of post-syncope, ICM-driven diagnosis following Standard Testing (ST) from a Turkish payer perspective.

METHODS: This analysis considers all costs of diagnosis via ST and ICM, the costs and consequences of recurrent syncope, and the cost of arrhythmia treatment following diagnosis. Cost inputs are derived from the Turkish Health Implementation Communique and published literature. A Markov model was developed to reflect the recurrence of syncopal events in undiagnosed patients. Arrhythmia diagnosis and recurrent syncope events in patients with unexplained syncope was modelled over a 10-year time horizon. All costs and consequences were discounted at a 3% annual rate, and extensive one-way sensitivity analyses (SA) were performed (100K MC Simulations). There is no official willingness to pay threshold in Turkey; therefore, it was assumed to be equal to three times GDP per capita at 79,038 Turkish Lira (TRY)/Quality Adjusted Life Year (QALY).

RESULTS: ICM is cost-effective with an ICER of 34,913.52 TRY/QALY. The mean incremental QALYs are estimated to be 0.417. In 1,000 patients, ICMs are estimated to identify 376 (IQ Range 287-481) more arrhythmic cases compared to ST. Extensive SA on key drivers confirmed the robustness of results. ICM is cost-effective, and below the assumed threshold approximately 78% of the time. Another 10% of the time, ICM delivers more value but at a cost higher than the assumed threshold.

CONCLUSIONS: The use of ICM substantially increases the arrhythmic diagnostic yield and guides treatment in more patients than ST. When considering all diagnostic costs in combination with the syncopal events avoided and quality of life (QoL), ICM arrhythmia diagnosis is a cost-effective alternative to ST.