Cost-Minimization Model in Cryptogenic Stroke: ePatch vs Implantable Loop Recorder in Patients from the UK, Netherlands, and Sweden

Vasily Lukyanov,1 Purvee Parikh,2 Manish Wadhwa,2 Alexandria Dunn,2 Roderick van Leerdam,1 Johan Engdahl,3 Goran Medic1 1Chief Medical Office, Philips Healthcare, Eindhoven, Netherlands; 2Chief Medical Office, Philips, San Diego, CA, USA; 3Karolinska Institutet, Danderyd Hospital, Stockholm, SwedenCorrespondence: Goran Medic, Chief Medical Office, Philips Healthcare, High Tech Campus 52, Eindhoven, Netherlands, Tel +31-(0)6-18 19 37 82, Email [email protected]: Patients who have experienced a cryptogenic stroke (CS) may benefit from extended monitoring and possible earlier detection of atrial fibrillation (AF), allowing for the timely initiation of appropriate pharmacotherapy.Objective: This economic study aimed to evaluate the clinical and cost outcomes of using mid-term cardiac monitors (referred to as “ePatch”) versus ILR-only in post-CS patients in the UK, Netherlands (NL) and Sweden.Methods: An existing cost-minimization model was modified to fit healthcare settings in the UK, Netherlands and Sweden. The model’s target population was composed of adult patients who had previously experienced a CS, but had no documented history of AF. The model compares the one-year direct medical costs between two groups: one group receiving wearable ePatch, the other group proceeding directly to ILR.Results: When applied to a group of 1,000 patients, the ePatch versus ILR approach resulted in cost savings, due to combination of reduced expenses and decreased modelled occurrence of recurrent strokes in all three countries studied. In the base case analysis, the cost savings per patient with detected AF for ePatch ranged from 3.4– 6.0 times, depending on the country.Conclusion: Utilizing ePatch extended wear Holter for mid-term ECG monitoring in CS patients represents a cost-saving alternative to monitoring with ILR. The cost savings were achieved by reducing device expenses and by prevention of recurrent strokes via earlier anticoagulation initiation. Preventing recurrent strokes in this population is highly significant, as it can lead to improved long-term health outcomes and reduced overall healthcare costs.Keywords: outpatient cardiac monitoring, stroke, holter, atrial fibrillation, electrocardiography, economic evaluation, secondary prevention, telemedicine, remote monitoring