New Cost-Effectiveness Data on Insertable Cardiac Monitors Published in JCER

Findings from a new economic analysis of insertable cardiac monitors (ICMs) in a U.S. cryptogenic stroke population were recently published in the Journal of Comparative Effectiveness Research.[1] The analysis found that ICMs, like the Medtronic LINQ™ Family of ICMs, are cost-effective in detecting atrial fibrillation (AF), which could help prevent secondary stroke in patients presenting with cryptogenic stroke in the U.S. healthcare system, compared to standard of care. Furthermore, use of ICMs immediately after a cryptogenic stroke was cost-saving compared to using an external monitor first. 

According to the American Stroke Association, cryptogenic stroke – or strokes with no identifiable cause – account for nearly 175,000 ischemic strokes every year in the U.S. Research has shown that this type of stroke can be caused by atrial fibrillation (AF). The current standard of care to diagnose AF after a stroke is to use ECGs to monitor patients’ heart rhythms. The use of ICMs is a more advanced alternative solution, recording continuous heart data through long-term monitoring to better detect AF and lead to anticoagulation therapy for the prevention of secondary stroke. 

“This is the first cost-effectiveness study of ICMs to diagnose cryptogenic strokes in the United States,” said Rob Kowal, M.D., Ph.D., chief medical officer of cardiovascular diagnostics & services at Medtronic. “This analysis demonstrates that trying Holter monitoring before implanting an ICM does not save money compared with just inserting an ICM immediately after a cryptogenic stroke; rather it is slightly more expensive. The data may help streamline the care pathway which includes ICM use in patients with cryptogenic stroke.”

Study Overview and Key Takeaways: 

• The findings were based on an economic model using data from the CRYSTAL-AF study looking at U.S. patients to estimate lifetime quality-adjusted life-years (QALY) and costs for three monitoring strategies:

          -ICM as the first monitoring strategy after a cryptogenic stroke

          -Standard of care (defined as intermittent ECGs and Holter monitoring utilized in control arm of CRYSTAL-AF study)

          -Use of an external short-term monitor first, followed by ICM in undiagnosed patients

• Compared to standard of care, the use of an ICM monitoring strategy was associated with a gain of 0.198 quality-adjusted life years (0.226 life-years) driven by higher rates of AF detection and oral anticoagulant therapy. Over a lifetime horizon, the ICM approach was projected to lead to 60 fewer lifetime ischemic strokes per 1,000 patients. The resulting incremental cost-effectiveness ratio (ICER) was $31,345 per QALY gained compared to standard of care, indicating that ICM is a cost-effective monitoring strategy in the U.S. environment. 
• Compared to a population with external, short-term monitoring (1 to 30 days) prior to ICM, patients who received ICM as the first cardiac monitoring strategy following a cryptogenic stroke diagnosis were projected to have average lower lifetime healthcare costs and modest quality of life improvements, supporting the clinical and economic value of starting with long-term monitoring in patients with cryptogenic stroke.

About Medtronic

Medtronic plc (www.medtronic.com), headquartered in Dublin, Ireland, is among the world's largest medical technology, services and solutions companies – alleviating pain, restoring health and extending life for millions of people around the world. Medtronic employs more than 90,000 people worldwide, serving physicians, hospitals and patients in more than 150 countries. The company is focused on collaborating with stakeholders around the world to take healthcare Further, Together.