Costs of testing

The cost of the ICM device, insertion and removal were based on blended Medicare and commercial payment data (table 3). Based on device monitoring data, 80% of insertion procedures occurred in an outpatient setting and 20% inpatient. All explants were outpatient procedures. One month after insertion, patients with ICM had an in-person check-up, and remote monitoring every month thereafter according to the Medicare allowable frequency. Though remote monitoring may occur less frequently, conservative cost savings were assumed.

Unit costs

*Payments are based on national average payments, and represent a weighted average between Medicare and commercial paid amounts based on the proportion of patients with syncope covered by Medicare (66%).

APC, ambulatory payment classification; CPT, current procedural terminology; DRG, diagnosis-related group; ICD-10, 10th Revision of the International Classification of Diseases; ICM, insertable cardiac monitor; USD, US dollar.

The cost of conventional testing in an outpatient setting was calculated by weighting blended reimbursement unit costs by the frequency of testing obtained from Optum claims analysis, plus the cost of the emergency visit and two specialist consultations based on clinical experience (table 1). The cost of CONV syncope evaluation in an inpatient setting was calculated based on the blended payer payment for a hospitalization with DRG 312 (Syncope and collapse) with no diagnosis code for physical injuries or trauma. The final cost of CONV assumed that 30% of patients received conventional testing in an outpatient setting.

Initial diagnostic work-up occurring prior to model entry was common to all patients, and hence was not included in the cost of either comparator.