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Cost implications of testing strategy in patients with syncope

Randomized assessment of syncope trial

Andrew D. Krahn, MD^*,*, George J. Klein, MD^*, Raymond Yee, MD^*, Jeffrey S. Hoch, PhD and Allan C. Skanes, MD^*

^* Division of Cardiology, Departments of Medicine, University of Western Ontario, London, Ontario, Canada
Epidemiology and Actuarial Sciences, University of Western Ontario, London, Ontario, Canada

View larger version (24K): [in a new window]   Figure 1 Outcome in 60 patients randomized to a primary diagnostic strategy of prolonged cardiac monitoring compared with conventional testing with an external loop recorder and tilt and electrophysiologic testing for investigation of syncope. Although the cost of monitoring was greater than that of conventional testing, the cost/diagnosis was reduced because of the greater diagnostic yield (p < 0.0001).

View larger version (18K): [in a new window]   Figure 2 Cost and diagnostic yield of the two treatment strategies. The results of the testing strategy are shown for all patients in the trial, including those who crossed over. The overall diagnostic yield of the two strategies was comparable, but the cost per diagnosis of the strategy of primary monitoring was significantly reduced by $2,016 (p = 0.002).