title: Cost comparison of two implantable cardiac monitors in two different settings: Reveal XT in a catheterization laboratory vs. Reveal LINQ in a procedure room.
abstract: OBJECTIVE
  Implantable cardiac monitors (ICMs) are used for long-term heart rhythm monitoring, e.g. to diagnose unexplained syncope or for detection of suspected atrial and ventricular arrhythmias. The newest ICM, Reveal LINQ™ (Medtronic Inc.), is miniaturized and inserted with a specific insertion tool kit. The procedure is therefore minimally invasive and can be moved from catheterization laboratory (cath lab) to a less resource intensive setting. This study aims to assess the change in procedure costs when performed outside the cath lab.
  
  
  RESULTS
  A bottom-up costing methodology was used. Data were collected from interviews with physicians, cath lab managers, and financial controllers. Hospitals in the Netherlands, France, and the UK were included in this study. The cost comparison of a Reveal XT implantation in a cath lab setting vs. a Reveal LINQ insertion outside a cath lab resulted in an estimated reduction of €662 for the UK, €682 for the Netherlands, and €781 for France. These cost savings were primarily realized through fewer staff, less equipment, and overhead costs. The net effect on savings depends on the price differential between these two technologies. The patient care pathway can be improved due to the possibility to move the procedure out of the cath lab.
  
  
  CONCLUSIONS
  Inserting the miniaturized version of the ICM is simpler and faster, and the procedure can take place outside the cath lab in a less resource intensive environment. Hospitals save resources when the higher price of the Reveal LINQ does not outweigh these savings.
authors: Institute for Medical Technology Assessment, Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam 3000 DR, The Netherlands kanters@bmg.eur.nl.
authors: Tim A
authors: TA
authors: Kanters
authors: Department of Health Economics and Reimbursement, Medtronic, Route du Molliau 31, Tolochenaz 1131, Switzerland.
authors: Claudia
authors: C
authors: Wolff
authors: Cardiac Catheter Suite, Queen Elizabeth the Queen Mother Hospital, Kent CT9 4AN, UK.
authors: David
authors: D
authors: Boyson
authors: Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, Lille 59000, France.
authors: Claude
authors: C
authors: Kouakam
authors: Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors: Trang
authors: T
authors: Dinh
authors: Institute for Medical Technology Assessment, Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam 3000 DR, The Netherlands.
authors: Leona
authors: L
authors: Hakkaart
authors: Institute for Medical Technology Assessment, Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, Rotterdam 3000 DR, The Netherlands.
authors: Maureen P M H
authors: MP
authors: Rutten-Van Mölken
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000175:diagnosis*; D003365:Costs and Cost Analysis; D015716:Electrocardiography, Ambulatory / Q000191:economics* / Q000295:instrumentation; D004567:Electrodes, Implanted / Q000191:economics*; D005602:France; D006761:Hospitals; D006801:Humans; D009426:Netherlands; D013575:Syncope / Q000209:etiology*; D006113:United Kingdom
keywords: Catheterization laboratory; Costs; Implantable cardiac monitor; Procedure room; Syncope