Implantable loop recorders are cost-effective when used to investigate transient loss of consciousness which is either suspected to be arrhythmic or remains unexplained

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Abstract
To assess the cost-effectiveness of implantable loop recorders (ILRs) in people with transient loss of consciousness (TLoC), which, after initial assessment and specialist cardiovascular assessment, is either suspected to be arrhythmic in origin or remains unexplained. This analysis was conducted to inform clinical guideline recommendations made by the National Institute for Health and Clinical Excellence (NICE) on the management of TLoC. Decision analytic modelling was used to estimate the costs and benefits of using ILRs compared with a strategy of no further diagnostic testing. Diagnostic outcomes were estimated from a systematic review and used to populate a decision tree model. To capture the main consequences of diagnosis, the costs and benefits of treatment for several clinically significant arrhythmias were estimated within the model. We used a cost-utility approach, in which benefits are measured using quality adjusted life years (QALYs), and took a UK National Health Service (NHS) and personal social services perspective. The cost per QALY was £17 400 in patients with unexplained syncope and £16 400 in patients with suspected arrhythmic syncope. Sensitivity analysis found that the cost-effectiveness estimates are fairly robust despite the areas of uncertainty identified in the evidence and assumptions used to inform the model. Implantable loop recorder monitoring is likely to be a cost-effective strategy in people presenting to the UK NHS who are experiencing infrequent episodes of TLoC which either remain unexplained or are suspected to be arrhythmic after initial assessment and specialist cardiovascular assessment. Implantable loop recorder monitoring has been recommended by NICE for these populations.

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