Premium
Cost Effectiveness of Implantable Cardiac Monitor‐Guided Intermittent Anticoagulation for Atrial Fibrillation: An Analysis of the REACT.COM Pilot Study
Author(s) -
STEINHAUS DANIEL A.,
ZIMETBAUM PETER J.,
PASSMAN ROD S.,
LEONGSIT PETER,
REYNOLDS MATTHEW R.
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13090
Subject(s) - medicine , atrial fibrillation , reimbursement , intensive care medicine , cost effectiveness , warfarin , population , emergency medicine , health care , cardiology , risk analysis (engineering) , economics , economic growth , environmental health
Cost‐Effectiveness of ICM Guided Anticoagulation for AF Introduction Anticoagulation guidelines for patients with atrial fibrillation (AF) disregard AF burden. A strategy of targeted anticoagulation with novel oral anticoagulants (NOACs) based on continuous rhythm assessment with an implantable cardiac monitor (ICM) has recently been explored. We evaluated the potential cost‐effectiveness of this strategy versus projected outcomes with continuous anticoagulation. Methods and Results We developed a Markov model using data from the Rhythm Evaluation for AntiCoagulaTion With COntinuous Monitoring (REACT.COM) pilot study (N = 59) and prior NOAC trials to calculate the costs and quality‐adjusted life years (QALYs) associated with ICM‐guided intermittent anticoagulation for AF versus standard care during a 3‐year time horizon. Health state utilities were estimated from the pilot study population using the SF‐12. Costs were based on current Medicare reimbursement. Over 14 ± 4 months of follow‐up, 18 of 59 patients had 35 AF episodes. The ICM‐guided strategy resulted in a 94% reduction in anticoagulant use relative to continuous treatment. There were no strokes, 3 (5.1%) TIAs, 2 major bleeding events (on aspirin) and 3 minor bleeding events with the ICM‐guided strategy. The projected total 3‐year costs were $12,535 for the ICM‐guided strategy versus $13,340 for continuous anticoagulation. Projected QALYs were 2.45 for both groups. Conclusion Based on a pilot study, a strategy of ICM‐guided anticoagulation with NOACs may be cost‐saving relative to expected outcomes with continuous anticoagulation, with similar quality‐adjusted survival. This strategy could be attractive from a health economic perspective if shown to be safe and effective in a rigorous clinical trial.