Abstract 336: Cost-effectiveness of Implantable Cardiac Monitor-guided Intermittent Anticoagulation for Paroxysmal Atrial Fibrillation
Bibliographic record
Abstract
Background: Patients with atrial fibrillation (AF) and stroke risk factors are recommended for treatment with long-term anticoagulation, even when rhythm control interventions result in a low AF burden. A strategy of guiding anticoagulation with novel oral anticoagulants (NOACs) based on daily transmissions from an implantable cardiac monitor (ICM) in CHADS 2 1 or 2 AF patients has recently been explored in a single-arm pilot study. The aim of our study was to evaluate the cost-effectiveness of this strategy versus projected outcomes with the current standard of continuous anticoagulation. Methods: We developed a Markov model using data from the Rhythm Evaluation for AntiCoagulaTion With COntinuous Monitoring (REACT.COM) pilot study (N=59) and previously completed anticoagulant trials to calculate the costs and quality-adjusted life years (QALYs) associated with ICM-guided intermittent anticoagulation for AF vs. standard care. The model time horizon was 3 years (the battery life of an ICM). Health state utilities were estimated from the pilot study population using the SF-12. Costs were based on current Medicare reimbursement. Results: In the pilot study, over 14±4 months of follow-up 18/59 patients were observed to have 35 AF episodes, 60% of which spontaneously terminated and 63% were asymptomatic. The protocol resulted in a >90% reduction in anticoagulant use relative to standard continuous treatment. There were no strokes, 2 (3.4%) TIAs, 2 major bleeding events (on aspirin) and 3 minor bleeding events with the ICM-guided strategy. The model projected total 3-year costs of $10,558 for the ICM-guided strategy vs. $12,898 for literature-based expected outcomes with continuous anticoagulation. Projected QALYs were 2.46 for both groups. Detailed sensitivity and scenario analyses are ongoing. Conclusions: Based on the REACT.COM pilot study, a strategy of intermittent, ICM-guided oral anticoagulation with NOACs was cost-saving relative to expected outcomes with continuous anticoagulation, with equivalent quality-adjusted survival. This strategy requires validation in a larger, randomized study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".