Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the US

Table 3 Cost and utilities of interventions, events and health states

Event, intervention or health state	Mean cost ($)	SE ($)	Mean utility	SE	Source
Stroke and bleed events†
Mild IS	21,567	3301	0.76	0.05	[24,25,26]
Moderate IS	25,124	3846	0.39	0.02
Severe IS	32,279	4941	0.11	0.01
Fatal IS	32,279	4941	0.00	–
Mild HS	23,622	3616	0.76	0.05
Moderate HS	33,408	5114	0.39	0.02
Severe HS	43,195	6611	0.11	0.01
Fatal HS	43,195	6611	0.00	–
Disutility for all recurrent (secondary) stroke events (acute period)	–		− 0.150	0.040	[23, 24]
Other events
Cost and disutility of other ICH	25,149	3849	− 0.181	0.014	[16, 17, 26, 27]
Cost and disutility of CRNM	1163	178	− 0.181	0.014
Cost and disutility of GI bleed	9136	1398	− 0.181	0.014
Cost and disutility of other ECH	13,813	2114	− 0.181	0.014
Health states before any event
Starting utility and No AF	–		0.81	0.008	[27]
Disutility for presence of AF	–		− 0.014	0.019	[24]
Post-stroke health states (per cycle)
Post mild stroke (IS or HS)	3239	496	0.76	0.012	[24,25,26]
Post moderate stroke (IS or HS)	8845	1354	0.45	0.035
Post severe stroke (IS or HS)	19,212	2941	0.34	0.065
Disutility for recurrent (secondary) stroke (post-acute period)	–		− 0.068	0.024	[23, 24]
One-time intervention costs
ICM acquisition and insertion	7042	1078	–	–	[28]
ICM removal	738	113	–	–	[28]
24-h Holter	102	16	–	–	[28]
ECG device	27.5	4	–	–	[28]
Monitoring and follow-up (per cycle)
ICM	119		–	–	[28, 29]
SoC monitoring	35		–	–	[28, 30]
Drug costs (per cycle)
Aspirin	54		–	–	[30]
Warfarin	18		–	–	[31]
Warfarin INR monitoring	25		–	–	[28]
NOAC^*	118		–	–	[30]

AF atrial fibrillation, ECH extracranial haemorrhage, GI gastrointestinal, HS hemorrhagic stroke, ICH intracranial haemorrhage, ICM insertable cardiac monitor, INR international normalised ratio, IS ischemic stroke, NOAC non-vitamin K oral anticoagulants, SE standard error, SoC standard of care
*NOAC drug cost was assumed to be the average of dabigatran, rivaroxaban, apixaban, and edoxaban; ^†confidence intervals associated with costs are assumed to be + / − 30%, utility values were updated for the heart failure subgroup, as detailed in the Additional file 1: Table S17

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