Insertable Cardiac Monitor
The insertable cardiac monitor (ICM) is a tiny, diagnostic device implanted under the skin that offers long term monitoring and detection of a person’s irregular heart rhythms (in this case, atrial fibrillation). Atrial fibrillation (AF) is a key risk factor in causing stroke. Accurate detection of AF by a physician allows for appropriate medical management of a patient and thereby reduces the risk of stroke. There is a significantly high impact on mortality and morbidity rates in individuals who suffer a second stroke. Patient and health system impacts can be responsibly managed by the accurate detection of AF in primary cryptogenic stroke survivors.
Through EXCITE, contextual evidence was generated that illustrated the benefits and associated costs of a long-term monitoring strategy for AF using an ICM in cryptogenic stroke patients from the perspective of patients, clinicians and decision makers. In addition, through collaborative consultation with key system stakeholders (including the Ontario Ministry of Health), the EXCITE process identified opportunities that inform the implementation and uptake of ICM technology for cryptogenic stroke patients across the Ontario health system.
Upon consideration of the evidence, the EXCITE Management Board has recommended the ICM class of technologies be considered for adoption by the Ontario Ministry of Health.Click Here to Read the Case Example
Continuous Glucose Monitor Sensor
Type I Diabetes results from the body’s inability to produce insulin to manage blood glucose levels. Often, patients use an insulin pump (a small, portable device) to deliver insulin to their body. To know when or how much insulin to deliver, patients typically use a finger prick technique to measure their blood glucose level. This process is not only inconvenient, but it relies heavily on a patient’s compliance to frequently complete this measurement and can omit important periods of glucose variability during the day and night. Unmanaged or insufficiently managed blood glucose can lead to acute high-risk situations resulting from low blood glucose (including death) or ultimately lead to serious long-term health consequences of diabetes including limb amputation, organ failure and vision loss.
The Sensor Augmented Pump with Continuous Glucose Monitoring (SAP-CGM) with Low Glucose Suspend offers real-time blood glucose monitoring and predictive alarms for changing blood glucose levels. SAP-CGM provides the opportunity for patients to maintain their blood glucose in the target range and thereby help to mitigate long term health consequences.
Insulin pumps are currently reimbursed by the Ontario health system for type 1 diabetes; CGM sensor technology is not.
Through EXCITE, a systematic review, qualitative evaluation and budget impact analysis was completed that further demonstrated the life-changing impact CGM sensor technology could have for patients, physicians and the health system overall. In addition, through collaborative consultation with key system stakeholders (including the Ontario Ministry of Health), the EXCITE process identified opportunities that informed the implementation and uptake of CGM technology across the Ontario health system.
Upon consideration of the evidence, the EXCITE Management Board recommended the CGM sensor class of technologies for adoption to the Ontario Ministry of Health, beginning with a targeted subpopulation with eventual broad rollout.
Obstructive Sleep Apnea Home Sleep Test
Obstructive sleep apnea occurs when the muscles in the throat relax during sleep, making it harder for air to get into the lungs thus preventing a good night’s sleep. Other symptoms include snoring, daytime sleepiness, morning headaches, difficulty concentrating, poor memory and irritability. Left untreated, sleep apnea can lead to serious health complications, including a three to four-fold increase in the risk of hypertension, stroke and heart failure. Sleep apnea is typically tested in an overnight sleep laboratory and can be perceived as costly to the system and cumbersome for patients.
The BresoDx® device is a portable, home-based and self-administered medical device that is used to help diagnose sleep apnea. It is worn over the nose and mouth and records breath sounds and head movements for up to eight hours of sleep. The recordings are captured in a report that is sent to the patient’s sleep physician for interpretation.
The EXCITE process allowed for the generation of contextual evidence that illustrated the benefits and costs associated with making the BresoDx® technology available in Ontario. The evaluation included a clinical and cost effectiveness assessment as well as a systematic review of diagnostic ability of portable monitors, such as BresoDx®, compared to the overnight sleep laboratory test.
Upon consideration of the evidence, the EXCITE Management Board has recommended BresoDx® for adoption by the Ontario Ministry of Health.Click Here to Read the Case Example