title: Tilt testing is more cost-effective than implantable loop recorder monitoring as a means of directing pacing therapy in people with recurrent episodes of suspected vasovagal syncope that affect their quality of life or present a high risk of injury.
abstract: OBJECTIVE
  To assess the cost-effectiveness of implantable loop recorders (ILRs) and tilt testing (TT) to direct pacing therapy in people with recurrent episodes of transient loss of consciousness that are adversely affecting their quality of life or represent a high risk of injury and are suspected to be vasovagal.
  
  
  METHODS
  Decision analytical modelling was used to estimate the costs and benefits of diagnostic testing including the costs and benefits of treatment for several clinically important arrhythmias following diagnosis.
  
  
  METHODS
  A UK National Health Service and personal social services perspective was taken.
  
  
  METHODS
  People with recurrent episodes of transient loss of consciousness that are adversely affecting their quality of life or represent a high risk of injury and which are suspected to be vasovagal.
  
  
  METHODS
  The diagnostic test strategies compared were TT alone, TT followed by ILR (if TT 'negative'), ILR alone and no further testing.
  
  
  METHODS
  Benefits measured using quality-adjusted life years and incremental cost-effectiveness ratios (ICER) are reported.
  
  
  RESULTS
  The ICERs for TT alone, ILR alone and TT followed by ILR were £5960, £24 620 and £19 110, respectively, compared with no testing. ILR alone was extendedly dominated by the other strategies, meaning that it is never the most cost-effective option. Sensitivity analysis found that the cost-effectiveness estimates were robust despite the areas of uncertainty identified in the evidence and assumptions used to inform the model.
  
  
  CONCLUSIONS
  TT alone is likely to be the most cost-effective strategy in this population.
authors.affiliation: Health Economics and Decision Science, The School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S1 4DA, UK. s.davis@shef.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Davis
authors.forename: Maggie
authors.initials: M
authors.lastname: Westby
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Petkar
authors.forename: David
authors.initials: D
authors.lastname: Pitcher
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004868:Equipment Failure / Q000191:economics; D006801:Humans; D018803:Models, Economic; D008991:Monitoring, Physiologic / Q000191:economics* / Q000379:methods; D010138:Pacemaker, Artificial / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000503:physiopathology / Q000628:therapy*