Cost-Effectiveness of Insertable Cardiac Monitor in Unexplained Syncope-Based on Real-World Data From China

The use of an insertable cardiac monitor (ICM) is recommended to help diagnose patients with unexplained syncope. Compared with conventional testing (CONV), ICM provides continuous long-term electrocardiogram (ECG) monitoring and has the ability to establish symptom-rhythm correlations, which is critical for patients with infrequent and randomized syncope. In China, the upfront cost of ICM is relatively high. However, the subsequent costs and outcomes of additional diagnostics and resulting treatments remain unclear. This study sought to evaluate the economic value of ICM versus CONV in patients with unexplained syncope and suspected of arrhythmia from the perspective of the China's healthcare system, aiming at informing clinical and policy decisions.

This study used a Markov model to assess the lifetime costs and benefits of ICM versus CONV for diagnosing syncope. In this model, the costs and effectiveness of all relevant diagnostic and follow-up arrhythmia-related treatments were considered. The study cohort characteristics and costs were obtained from a retrospective real-world study conducted in Sichuan Provincial People's Hospital. The mortality rate, syncope recurrence rate, syncope-related injury rate, and quality of life estimates were obtained from published literature. Total costs and quality-adjusted life years (QALYs) were modeled for two strategies, and the incremental cost-effectiveness ratio (ICER) was calculated. Three times China's GDP per capita in 2023 was used as a willingness-to-pay (WTP) threshold.

ICM was predicted to be more expensive but more effective than CONV. The base-case results showed that the average cost of the ICM group was 111 733 CNY with QALYs of 10.28, while the average cost of the CONV group was 88 386 CNY with QALYs of 10.08. The ICER was calculated to be 115 596 CNY/QALY. With China's GDP per capita in 2023 being 89 358 CNY, the ICER was < 1.5 times the GDP per capita, and similar results were shown in the scenario analysis.

This analysis suggests that ICM is a cost-effective strategy, versus conventional testing, for the diagnosis of unexplained syncope in China, and supports wider uptake of the technology.