Tilt testing is more cost-effective than implantable loop recorder monitoring as a means of directing pacing therapy in people with recurrent episodes of suspected vasovagal syncope that affect their quality of life or present a high risk of injury
- 1Health Economics and Decision Science, The School of Health and Related Research, The University of Sheffield, Sheffield, UK
- 2The National Clinical Guideline Centre, The Royal College of Physicians, London, UK
- 3Department of Cardiology, Inherited Cardiac Conditions Clinic, Queen Elizabeth Hospital, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- 4University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Correspondence to Sarah Davis, Health Economics and Decision Science, The School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, South Yorkshire S1 4DA, UK; s.davis{at}shef.ac.uk
- Received 6 August 2012
- Revised 18 October 2012
- Accepted 13 November 2012
- Published Online First 12 December 2012
Abstract
Objective To assess the cost-effectiveness of implantable loop recorders (ILRs) and tilt testing (TT) to direct pacing therapy in people with recurrent episodes of transient loss of consciousness that are adversely affecting their quality of life or represent a high risk of injury and are suspected to be vasovagal.
Design Decision analytical modelling was used to estimate the costs and benefits of diagnostic testing including the costs and benefits of treatment for several clinically important arrhythmias following diagnosis.
Setting A UK National Health Service and personal social services perspective was taken.
Patients People with recurrent episodes of transient loss of consciousness that are adversely affecting their quality of life or represent a high risk of injury and which are suspected to be vasovagal.
Interventions The diagnostic test strategies compared were TT alone, TT followed by ILR (if TT ‘negative’), ILR alone and no further testing.
Main outcome measures Benefits measured using quality-adjusted life years and incremental cost-effectiveness ratios (ICER) are reported.
Results The ICERs for TT alone, ILR alone and TT followed by ILR were £5960, £24 620 and £19 110, respectively, compared with no testing. ILR alone was extendedly dominated by the other strategies, meaning that it is never the most cost-effective option. Sensitivity analysis found that the cost-effectiveness estimates were robust despite the areas of uncertainty identified in the evidence and assumptions used to inform the model.
Conclusions TT alone is likely to be the most cost-effective strategy in this population.
