Browsing by Author "Hofmeister, Mark Ronald"

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    An Economic Evaluation of the Syncope: Pacing or Recording in the Later Years (SPRITELY) Trial
    (2018-07-06) Hofmeister, Mark Ronald; Clement, Fiona M.; Spackman, David Eldon; Sheldon, Robert S.
    The Syncope: Pacing or Recording In ThE Later Years (SPRITELY) trial tests the hypothesis that pacemaker insertion in patients with syncope, bifascicular block, and age greater than 50 years prevents syncope recurrences and major clinical events more effectively than therapy guided by monitoring with an implantable loop recorder. Equipoise or uncertainty reflected in guidelines and recommendations for both strategies may contribute to variation in management and inefficient resource use. Clinical analysis of the SPRITELY trial is complemented with an economic evaluation. The goal of this thesis was to establish the relative cost-effectiveness of the implantable loop recorder and the pacemaker in patients with bifascicular block, unexplained syncope, and age greater than 50 years. An economic evaluation of the SPRITELY trial was conducted to match the prespecified time horizon of two years for the clinical analysis (Chapter 3), and a decision analytic model was built to extend the time horizon to three years to match clinical practice (Chapter 4). In Chapter 5, the effect of taking three different national perspectives for the SPRITELY trial evaluation was explored. This thesis ends with a discussion and conclusions in Chapter 6.