Economic evaluation of prolonged and enhanced ECG Holter monitoring in acute ischemic stroke patients

Sandra Diekmann, Laura Hoerster, Silvia Evers, Mickael Hiligsmann, Goetz Gelbrich, Klaus Groeschel, Rolf Wachter, Gerhard F. Hamann, Pawel Kermer, Jan Liman, Mark Weber-Krueger, Juergen Wasem, Anja Neumann*, Find-AF RANDOMISED Investigators and Coordinators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: Atrial fibrillation (AF) is a major cause for recurrent stroke, has severe impact on a patient's health and imposes a high economic burden for society. Current guidelines recommend 24 h ECG monitoring (standard-of-care, SoC) to detect AF after stroke to reduce the risk of future events. However, paroxysmal AF (PAF) is difficult to detect within this period as it occurs infrequently and unpredictably. In a randomized controlled trial (Find-AF(RANDOMISED)), prolonged and enhanced Holter ECG monitoring (EPM) revealed a significantly higher detection rate of AF compared to SoC, although its cost-effectiveness has not yet been investigated. Methods: Based on the data of FIND-AF(RANDOMISED), an economic evaluation was conducted. One group received EPM for 10 days after the event, and at 3 and 6 months; the other group received SoC. Healthcare resource use and quality of life (QoL) data were measured at baseline, and after 6 and 12 months. Incremental costs and quality-adjusted life years (QALYs) between both groups were compared. Non-parametric bootstrapping and one-way-sensitivity analyses were performed. Results: A total of 281 patients with healthcare resource use and QoL data for all measurement points were considered in the economic evaluation (complete case analysis, CCA). The CCA yielded nonsignificant 315euro lower mean costs and 0.0013 less QALYs for patients receiving EPM with no statistically significant differences in any cost categories. Sensitivity analyses revealed robust results. Bootstrapping the results indicated moderate probability of cost-effectiveness. Conclusions: EPM yielded reduced not significantly different costs without affecting QoL and may be a useful strategy to detect PAF in acute ischemic stroke patients in time.
Original languageEnglish
Pages (from-to)1859-1866
Number of pages8
JournalCurrent Medical Research and Opinion
Issue number11
Early online date23 Aug 2019
Publication statusPublished - 2 Nov 2019


  • Atrial fibrillation
  • secondary prevention
  • cost-benefit analysis
  • quality-adjusted life years
  • stroke

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