Cost-Effectiveness of an Antibacterial Envelope for CIED Infection Prevention in the US Healthcare System from the WRAP-IT Trial.
Citation: Circulation: Arrhythmia and Electrophysiology. 13(10):e008503, 2020 10.PMID: 32915063Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anti-Bacterial Agents/ec [Economics] | *Antibiotic Prophylaxis/ec [Economics] | *Cardiac Resynchronization Therapy Devices/ec [Economics] | *Defibrillators, Implantable/ec [Economics] | *Drug Costs | *Prosthesis Implantation/ec [Economics] | *Prosthesis-Related Infections/ec [Economics] | Absorbable Implants/ec [Economics] | Anti-Bacterial Agents/tu [Therapeutic Use] | Cardiac Resynchronization Therapy Devices/ae [Adverse Effects] | Clinical Decision-Making | Cost Savings | Cost-Benefit Analysis | Decision Trees | Defibrillators, Implantable/ae [Adverse Effects] | Humans | Models, Economic | Multicenter Studies as Topic | Prosthesis Implantation/ae [Adverse Effects] | Prosthesis Implantation/is [Instrumentation] | Prosthesis-Related Infections/mi [Microbiology] | Prosthesis-Related Infections/pc [Prevention & Control] | Quality of Life | Quality-Adjusted Life Years | Randomized Controlled Trials as Topic | Risk Factors | Time Factors | Treatment Outcome | United StatesYear: 2020Local holdings: Available online from MWHC library: 2008 - presentISSN:- 1941-3084
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 32915063 | Available | 32915063 |
Available online from MWHC library: 2008 - present
Background - In the WRAP-IT trial, adjunctive use of an absorbable antibacterial envelope resulted in a 40% reduction of major cardiac implantable electronic device (CIED) infection without increased risk of complication in 6,983 patients undergoing CIED revision, replacement, upgrade, or initial cardiac resynchronization therapy defibrillator (CRT-D) implant. There is limited information on the cost-effectiveness of this strategy. As a pre-specified objective, we evaluated antibacterial envelope cost-effectiveness compared to standard-of-care infection prevention strategies in the US healthcare system. Methods - A decision tree model was used to compare costs and outcomes of antibacterial envelope (TYRX) use adjunctive to standard-of-care infection prevention vs. standard-of-care alone over a lifelong time horizon. The analysis was performed from an integrated payer-provider network perspective. Infection rates, antibacterial envelope effectiveness, infection treatment costs and patterns, infection-related mortality, and utility estimates were obtained from the WRAP-IT trial. Life expectancy and long-term costs associated with device replacement, follow-up, and healthcare utilization were sourced from the literature. Costs and quality-adjusted life years (QALYs) were discounted at 3%. An upper willingness-to-pay (WTP) threshold of 50,000 per QALY was used to determine cost-effectiveness, in alignment with American College of Cardiology and American Heart Association (ACC/AHA) practice guidelines and as supported by the World Health Organization (WHO) and contemporary literature. Results - The base-case incremental cost-effectiveness ratio (ICER) of the antibacterial envelope compared to standard-of-care was 12,603/QALY. The ICER remained lower than the WTP threshold in 74% of iterations in the probabilistic sensitivity analysis and was most sensitive to the following model inputs: infection-related mortality, life expectancy, and infection cost. Conclusions - The absorbable antibacterial envelope was associated with a cost-effectiveness ratio below contemporary benchmarks in the WRAP-IT patient population, suggesting that the envelope provides value for the US healthcare system by reducing the incidence of CIED infection.
English