{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:18:25Z","timestamp":1764173905379,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2012,11,13]]},"published-print":{"date-parts":[[2013,6,1]]},"abstract":"\n Objective<\/jats:title>\n To assess the cost-effectiveness of implantable loop recorders (ILRs) and tilt testing (TT) to direct pacing therapy in people with recurrent episodes of transient loss of consciousness that are adversely affecting their quality of life or represent a high risk of injury and are suspected to be vasovagal.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Decision analytical modelling was used to estimate the costs and benefits of diagnostic testing including the costs and benefits of treatment for several clinically important arrhythmias following diagnosis.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n A UK National Health Service and personal social services perspective was taken.<\/jats:p>\n <\/jats:sec>\n \n Patients<\/jats:title>\n People with recurrent episodes of transient loss of consciousness that are adversely affecting their quality of life or represent a high risk of injury and which are suspected to be vasovagal.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n The diagnostic test strategies compared were TT alone, TT followed by ILR (if TT \u2018negative\u2019), ILR alone and no further testing.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Benefits measured using quality-adjusted life years and incremental cost-effectiveness ratios (ICER) are reported.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The ICERs for TT alone, ILR alone and TT followed by ILR were \u00a35960, \u00a324\u2005620 and \u00a319\u2005110, respectively, compared with no testing. ILR alone was extendedly dominated by the other strategies, meaning that it is never the most cost-effective option. Sensitivity analysis found that the cost-effectiveness estimates were robust despite the areas of uncertainty identified in the evidence and assumptions used to inform the model.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n TT alone is likely to be the most cost-effective strategy in this population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/heartjnl-2012-302851","type":"journal-article","created":{"date-parts":[[2012,12,12]],"date-time":"2012-12-12T21:26:00Z","timestamp":1355347560000},"page":"805-810","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Tilt testing is more cost-effective than implantable loop recorder monitoring as a means of directing pacing therapy in people with recurrent episodes of suspected vasovagal syncope that affect their quality of life or present a high risk of injury"],"prefix":"10.1136","volume":"99","author":[{"given":"Sarah","family":"Davis","sequence":"first","affiliation":[{"name":"Health Economics and Decision Science, The School of Health and Related Research, The University of Sheffield, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maggie","family":"Westby","sequence":"additional","affiliation":[{"name":"The National Clinical Guideline Centre, The Royal College of Physicians, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjiv","family":"Petkar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, New Cross Hospital,The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Pitcher","sequence":"additional","affiliation":[{"name":"Inherited Cardiac Conditions Clinic, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2012,12,12]]},"reference":[{"key":"2025092012345362000_99.11.805.1","unstructured":"Westby M Davis S Bullock I . Transient loss of consciousness (\u2018blackouts\u2019) management in adults and young people. London: National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians, 2010. http:\/\/guidance.nice.org.uk\/CG109 (accessed 1 Sep 2011)."},{"key":"2025092012345362000_99.11.805.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp298"},{"key":"2025092012345362000_99.11.805.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl164"},{"key":"2025092012345362000_99.11.805.4","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.193417"},{"key":"2025092012345362000_99.11.805.5","unstructured":"National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Health and Clinical Excellence, 2008."},{"key":"2025092012345362000_99.11.805.6","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eur343"},{"key":"2025092012345362000_99.11.805.7","unstructured":"Department of Health. NHS reference costs 2007\u201308. London: Department of Health, 2009."},{"key":"2025092012345362000_99.11.805.8","unstructured":"National Horizon Scanning Centre. Reveal plus implantable loop recorders for the investigation of syncope and other events\u2014Horizon Scanning review. Birmingham, UK: National Horizon Scanning Centre, 2004."},{"key":"2025092012345362000_99.11.805.9","unstructured":"Personal Social Services Research Unit (PSSRU). Unit cost of health and social care 2008. Kent, UK: Personal Social Services Research Unit, 2008."},{"key":"2025092012345362000_99.11.805.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.280.6208.139"},{"key":"2025092012345362000_99.11.805.11","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.53.6.587"},{"key":"2025092012345362000_99.11.805.12","doi-asserted-by":"crossref","unstructured":"Castelnuovo E Stein K Pitt M . The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation. Health Technol Assess 2005;9.","DOI":"10.3310\/hta9430"},{"key":"2025092012345362000_99.11.805.13","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.1.260"},{"key":"2025092012345362000_99.11.805.14","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.082313"},{"key":"2025092012345362000_99.11.805.15","doi-asserted-by":"crossref","unstructured":"Buxton M Caine N Chase D . A review of the evidence on the effects and costs of implantable cardioverter defibrillator therapy in different patient groups, and modelling of cost-effectiveness and cost-utility for these groups in a UK context. Health Technol Assess 2006;10.","DOI":"10.3310\/hta10270"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2012-302851","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T19:35:05Z","timestamp":1758396905000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2012-302851"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,12,12]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2013,5,1]]},"published-print":{"date-parts":[[2013,6,1]]}},"alternative-id":["10.1136\/heartjnl-2012-302851"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2012-302851","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"type":"print","value":"1355-6037"},{"type":"electronic","value":"1468-201X"}],"subject":[],"published":{"date-parts":[[2012,12,12]]}}}