{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:48:31Z","timestamp":1786978111955,"version":"build-2736575974"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T00:00:00Z","timestamp":1624320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Arrhythmia"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Detection of atrial fibrillation (AF) is required to initiate oral anticoagulation (OAC) after cryptogenic stroke (CS). However, paroxysmal AF can be difficult to diagnose with short term cardiac monitoring. Taking an Australian payer perspective, we evaluated whether long\u2010term continuous monitoring for 3\u00a0years with an insertable cardiac monitor (ICM) is cost\u2010effective for preventing recurrent stroke in patients with CS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A lifetime Markov model was developed to simulate the follow\u2010up of patients, comparing long\u2010term continuous monitoring with an ICM to monitoring by conventional care. We used a linked evidence approach to estimate the rates of recurrent stroke when AF detection leads to initiation of OAC, as detected using ICM during the lifetime of the device or as detected using usual care. All diagnostic and patient management costs were modeled. Other model inputs were determined by literature review. Probabilistic sensitivity analysis (PSA) was undertaken to explore the effect of parameter uncertainty according to CHADS\n                      <jats:sub>2<\/jats:sub>\n                      score and OAC treatment effect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the base\u2010case analysis, the model predicted an incremental cost\u2010effectiveness ratio (ICER) of A$29\u00a0570 per quality\u2010adjusted life year (QALY). Among CHADS\n                      <jats:sub>2<\/jats:sub>\n                      subgroups analyses, the ICER ranged from A$26\u00a0342\/QALY (CHADS\n                      <jats:sub>2<\/jats:sub>\n                      \u00a0=\u00a06) to A$42\u00a0967\/QALY (CHADS\n                      <jats:sub>2<\/jats:sub>\n                      \u00a0=\u00a02). PSA suggested that the probabilities of ICM strategy being cost\u2010effective were 53.4% and 78.7%, at thresholds of $30\u00a0000 (highly cost\u2010effective) and $50\u00a0000 per QALY (cost\u2010effective), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long\u2010term continuous monitoring with an ICM is a cost\u2010effective intervention to prevent recurrent stroke in patients following CS in the Australian context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/joa3.12586","type":"journal-article","created":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T10:35:35Z","timestamp":1624358135000},"page":"1077-1085","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cost\u2010effectiveness of insertable cardiac monitors for diagnosis of atrial fibrillation in cryptogenic stroke in Australia"],"prefix":"10.1002","volume":"37","author":[{"given":"Vincent","family":"Thijs","sequence":"first","affiliation":[{"name":"Florey Institute of Neuroscience and Mental Health University of Melbourne Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus K.","family":"Witte","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular and Diabetes Research University of Leeds Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmel","family":"Guarnieri","sequence":"additional","affiliation":[{"name":"THEMA Consulting Pty Ltd. Pyrmont New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Makino","sequence":"additional","affiliation":[{"name":"THEMA Consulting Pty Ltd. Pyrmont New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Tilden","sequence":"additional","affiliation":[{"name":"THEMA Consulting Pty Ltd. Pyrmont New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Medtronic Australasia Pty Ltd. Macquarie Park New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Huynh","sequence":"additional","affiliation":[{"name":"Medtronic Australasia Pty Ltd. Macquarie Park New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,22]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Stroke Foundation. 2018.Top 10 facts about stroke.https:\/\/strokefoundation.org.au\/About\u2010Stroke\/Facts\u2010and\u2010figures\u2010about\u2010stroke. 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