title: Financial impact of adopting implantable loop recorder diagnostic for unexplained syncope compared with conventional diagnostic pathway in Portugal.
abstract: BACKGROUND
  To estimate the short- and long-term financial impact of early referral for implantable loop recorder diagnostic (ILR) versus conventional diagnostic pathway (CDP) in the management of unexplained syncope (US) in the Portuguese National Health Service (PNHS).
  
  
  METHODS
  A Markov model was developed to estimate the expected number of hospital admissions due to US and its respective financial impact in patients implanted with ILR versus CDP. The average cost of a syncope episode admission was estimated based on Portuguese cost data and landmark papers. The financial impact of ILR adoption was estimated for a total of 197 patients with US, based on the number of syncope admissions per year in the PNHS. Sensitivity analysis was performed to take into account the effect of uncertainty in the input parameters (hazard ratio of death; number of syncope events per year; probabilities and unit costs of each diagnostic test; probability of trauma and yield of diagnosis) over three-year and lifetime horizons.
  
  
  RESULTS
  The average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Over a lifetime horizon, the total discounted costs of hospital admissions and syncope diagnosis for the entire cohort were 23% lower amongst patients in the ILR group compared with the CDP group (1,204,621€ for ILR, versus 1,571,332€ for CDP).
  
  
  CONCLUSIONS
  The utilization of ILR leads to an earlier diagnosis and lower number of syncope hospital admissions and investigations, thus allowing significant cost offsets in the Portuguese setting. The result is robust to changes in the input parameter values, and cost savings become more pronounced over time.
authors.affiliation: Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra, Portugal. rui_providencia@yahoo.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.forename: Rui
authors.initials: R
authors.lastname: Candeias
authors.forename: Carlos
authors.initials: C
authors.lastname: Morais
authors.forename: Hipólito
authors.initials: H
authors.lastname: Reis
authors.forename: Luís
authors.initials: L
authors.lastname: Elvas
authors.forename: Vitor
authors.initials: V
authors.lastname: Sanfins
authors.forename: Sara
authors.initials: S
authors.lastname: Farinha
authors.forename: Simon
authors.initials: S
authors.lastname: Eggington
authors.forename: Stelios
authors.initials: S
authors.lastname: Tsintzos
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D019091:Critical Pathways / Q000191:economics*; D042241:Early Diagnosis; D015716:Electrocardiography, Ambulatory / Q000191:economics* / Q000295:instrumentation; D004867:Equipment Design; D017721:Hospital Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D010343:Patient Admission / Q000191:economics; D011174:Portugal; D011237:Predictive Value of Tests; D011379:Prognosis; D013575:Syncope / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D013686:Telemetry / Q000191:economics* / Q000295:instrumentation; D013997:Time Factors