Abstract
Mobile Cardiac Monitorization (MCT) frequently detects paroxysmal atrial fibrillation (PAF) in patients with cryptogenic stroke and transient ischemic accident (TIA). Length of monitoring is strongly associated with detection of PAF, with an optimal monitoring period of at least 21 days. The diagnostic yield of patients monitored with MCT is 61%. This is significantly higher than that of patients who use the Event monitor (23%) or the Holter monitor (24%). The aim of the analysis is to conduct a cost-effectiveness analysis of MCT versus Holter monitorization, with direct cost and payer perspective in atrial fibrillation. Literature search was conducted to understand Atrial Fibrillation (AF) diagnosis process with MCT or Holter, treatment process and health outcomes with or without treatment. A decision tree and Markov model were conducted for calculating the cost effectiveness of MCT vs. Holter monitorization. A healthcare utilization and outcomes questionnaire was prepared based on literature and conducted with 3 Turkish Key Opinion Leaders (KOLs) for understanding the pathway of AF diagnosis and treatment in Turkey. Cost of healthcare utilization with direct cost to Social Security Institution was included in the study with a payer perspective. Monte Carlo simulation and probabilistic sensitivity analysis were conducted. TreeAge Pro 2017 program was used for running the cost effectiveness analysis. MCT is cost effective compared to Holter for the diagnosis and management of Atrial Fibrillation with an ICER of 12.839 TL/year depending on WHO’s cost-effectiveness threshold criteria. In 95% of results of cost-effectiveness analysis of 1,000 samples using Monte Carlo Distribution were found that MCT is cost-effective compared to Holter. Early diagnosis is feasible with MCT, which would yield lower healthcare costs for payers. The study findings suggest that MCT is a cost-effective diagnosis tool compared to Holter for Atrial Arrhythmia from payer perspective in Turkey.
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