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Table 5 Subgroup analysis by CHADS2 score and scenario analyses

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

Scenario description

ICER per QALY

Incremental cost

Incremental QALYs

ICM versus SoC

Base case

$5786

0.16

$35,528

Sub-group analyses*

CHADS2 score 2

$6409

0.12

$55,059

CHADS2 score 3

$5867

0.16

$37,118

CHADS2 score 4, 5, and 6

$5792

0.13

$43,803

Scenario analyses

Choice of NOAC = warfarin

$5950

0.11

$56,916

Cost of aspirin = $0

$5917

0.16

$36,328

Treatment discontinuation for reasons other than bleeding = 0%

$4933

0.31

$15,843

ICM battery life 4.5 years

$5777

0.17

$33,229

ICM battery life 4.5 years, assume linear extrapolation

$5786

0.20

$27,986

ICM battery life 4.5 years, assume no AF after 30-month trial data

$5806

0.16

$37,594

Monitoring costs for SoC: assume pulse check and HR of ICM versus SoC is 1/24th of the Holter monitoring (scenario proposed by clinical experts)

$6954

0.17

$40,992

Assume SoC consists of one 24-Holter in the first cycle

$6773

0.17

$31,116

AF episode duration lasting for ≥ 5.5 h†

$6713

0.08

$86,013

NOAC uptake after AF diagnosis = 66.35%

$6301

0.12

$54,368

Time horizon = 5 years

$6433

0.02

$261,147

Time horizon = 10 years

$5797

0.08

$75,047

Time horizon = 25 years

$5776

0.16

$35,771

Heart failure subgroup base case

$6236

0.19

$33,273

Scenarios

Choice of NOAC = warfarin

$6384

0.13

$50,659

ICM battery life 4.5 years

$6193

0.20

$30,777

ICM battery life 4.5 years, assume linear extrapolation

$5837

0.28

$20,967

ICM battery life 4.5 years, assume no AF after 2-year trial data

$6508

0.19

$34,332

  1. AF atrial fibrillation, HR hazard ratio, ICER incremental cost-effectiveness ratio, ICM insertable cardiac monitor, NOAC non-vitamin K oral anticoagulants, QALY quality-adjusted life-year, SoC standard of care
  2. *Each CHADS2 subgroup will differ on ischemic stroke risk, diagnostic accuracy of monitoring strategies, as well as the corresponding age and gender mix of the group in the REVEAL AF trial; †analyses using the alternative definition of AF episode were carried out using the REVEAL AF clinical dataset (Data on file, Medtronic 2018)