Cost-effectiveness of an insertable cardiac monitor to detect atrial fibrillation in large- or small-vessel disease ischaemic stroke in the USA

Objectives To evaluate the cost-effectiveness of insertable cardiac monitors (ICMs) compared to standard of care (SoC) to detect atrial fibrillation (AF) in patients with stroke of presumed known cause of large-artery atherosclerotic disease (LAD) or small-vessel occlusive disease (SVD) from a US payer perspective. Design A lifetime Markov model assessed cost-effectiveness of ICM versus SoC from a US payer perspective.

Patient characteristics and AF detection rates were based on the STROKE AF trial (NCT02700945): 3-year diagnostic yield was 21.7% (95% CI 16.7% to 27.9%) for ICM and 2.4% (1.0% - 5.7%) for SoC. AF detection resulted in a switch from aspirin to direct oral anticoagulant unless precluded by prior bleeding.

Subsequent risks of ischaemic strokes (ISs) and bleeding events were modelled based on published literature. Costs and effects were discounted at 3% annually.

Specific SoC short-term monitoring strategies (STMs) were explored as scenarios. Setting US healthcare system perspective.

Participants Hypothetical cohort of patients with IS believed to be due to LAD or SVD. Interventions Patients received an ICM within ten days of the index stroke or SoC involving conventional follow-up.