Open Access Highly Accessed Research article

Financial impact of adopting implantable loop recorder diagnostic for unexplained syncope compared with conventional diagnostic pathway in Portugal

Rui Providência129*, Rui Candeias3, Carlos Morais4, Hipólito Reis5, Luís Elvas1, Vitor Sanfins6, Sara Farinha7, Simon Eggington8 and Stelios Tsintzos8

Author Affiliations

1 Centro Hospitalar e Universitário de Coimbra, Serviço de Cardiologia, Coimbra, Portugal

2 Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal

3 Hospital de Faro EPE, Faro, Portugal

4 Hospital Prof. Doutor Fernando da Fonseca EPE, Amadora, Portugal

5 Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal

6 Hospital de Guimarães, Centro Hospitalar do Alto Ave EPE, Guimarães, Portugal

7 Medtronic, Lisboa, Portugal

8 Medtronic, Tolochenaz, Switzerland

9 Serviço de Cardiologia, Hospital Geral do, Centro Hospital e Universitário de Coimbra, Quinta dos Vales, 3041-801 S. Martinho do Bispo, Coimbra, Portugal

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BMC Cardiovascular Disorders 2014, 14:63  doi:10.1186/1471-2261-14-63

Published: 6 May 2014



To estimate the short- and long-term financial impact of early referral for implantable loop recorder diagnostic (ILR) versus conventional diagnostic pathway (CDP) in the management of unexplained syncope (US) in the Portuguese National Health Service (PNHS).


A Markov model was developed to estimate the expected number of hospital admissions due to US and its respective financial impact in patients implanted with ILR versus CDP. The average cost of a syncope episode admission was estimated based on Portuguese cost data and landmark papers. The financial impact of ILR adoption was estimated for a total of 197 patients with US, based on the number of syncope admissions per year in the PNHS. Sensitivity analysis was performed to take into account the effect of uncertainty in the input parameters (hazard ratio of death; number of syncope events per year; probabilities and unit costs of each diagnostic test; probability of trauma and yield of diagnosis) over three-year and lifetime horizons.


The average cost of a syncope event was estimated to be between 1,760€ and 2,800€. Over a lifetime horizon, the total discounted costs of hospital admissions and syncope diagnosis for the entire cohort were 23% lower amongst patients in the ILR group compared with the CDP group (1,204,621€ for ILR, versus 1,571,332€ for CDP).


The utilization of ILR leads to an earlier diagnosis and lower number of syncope hospital admissions and investigations, thus allowing significant cost offsets in the Portuguese setting. The result is robust to changes in the input parameter values, and cost savings become more pronounced over time.

Syncope; Implantable loop recorder; Emergency department; Budget impact analysis