Dymond Amy, Barker E, Tsitiridis N, Schmetz A, Hilpert S Thompson, Jøns C, Behrens S, Søgaard P, Green W
York Health Economics Consortium, York, UK.
BIOTRONIK SE & Co. KG, Berlin, Germany.
Pharmacoecon Open. 2025 Jul 25. doi: 10.1007/s41669-025-00595-x.
Patients surviving a non-ST-elevation myocardial infarction (NSTEMI) have an elevated risk of future major adverse cardiovascular events (MACE), which can be mitigated through long-term cardiac arrhythmia monitoring. The present study evaluated the cost-effectiveness of continuous remote arrhythmia monitoring using an insertable cardiac monitor (ICM) combined with standard of care (SoC) compared with SoC alone.
A cost-effectiveness analysis using a lifetime partitioned survival model was developed for high-risk NSTEMI patients from a UK National Health Service (NHS) perspective. Survival analysis was used to determine the transition of patients from the pre-MACE health state (where patients could experience arrhythmia, major bleeding, or systemic embolism) to the MACE health state (worsening heart failure, stroke, and acute coronary syndrome events). The survival analysis and arrhythmia diagnosis rates were informed by the BIO|GUARD-MI trial. The model captured direct costs associated with each MACE and implantation and removal of the ICM device and treatment costs following arrhythmia detection. The model captured the health implications for an ICM with SoC, compared with SoC alone, in terms of the total quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were undertaken to explore the impact of parameter uncertainty on the model results.
The use of ICMs plus SoC for daily remote cardiac arrhythmia monitoring is cost effective, when compared with SoC alone, in high-risk NSTEMI patients over a lifetime horizon, with an incremental cost-effectiveness ratio of £7766 per QALY gained. The ICM was associated with an additional 0.184 QALYs per patient for an additional cost of £1430. The ICM remained cost effective during the deterministic and probabilistic sensitivity analyses.
The addition of an ICM to SoC in high-risk NSTEMI patients is cost effective from the perspective of the UK NHS and would, therefore, be a further option for the management of such patients in clinical practice.
非ST段抬高型心肌梗死（NSTEMI）存活患者未来发生主要不良心血管事件（MACE）的风险升高，通过长期心律失常监测可降低该风险。本研究评估了使用植入式心脏监测器（ICM）联合标准治疗（SoC）进行连续远程心律失常监测与单纯SoC相比的成本效益。
从英国国家医疗服务体系（NHS）的角度，为高危NSTEMI患者建立了一个使用终身分段生存模型的成本效益分析。生存分析用于确定患者从前MACE健康状态（患者可能经历心律失常、大出血或系统性栓塞）到MACE健康状态（心力衰竭恶化、中风和急性冠状动脉综合征事件）的转变。生存分析和心律失常诊断率以BIO|GUARD-MI试验为依据。该模型涵盖了与每个MACE以及ICM设备植入和移除相关的直接成本，以及心律失常检测后的治疗成本。该模型从总质量调整生命年（QALY）方面捕捉了ICM联合SoC与单纯SoC相比对健康的影响。进行了确定性和概率性敏感性分析，以探讨参数不确定性对模型结果的影响。
与单纯SoC相比，在高危NSTEMI患者的终身范围内，使用ICM联合SoC进行每日远程心律失常监测具有成本效益，每获得一个QALY的增量成本效益比为7766英镑。ICM使每位患者额外获得0.184个QALY，额外成本为1430英镑。在确定性和概率性敏感性分析期间，ICM仍然具有成本效益。
从英国NHS的角度来看，在高危NSTEMI患者中，在SoC基础上加用ICM具有成本效益，因此在临床实践中是管理此类患者的又一选择。
