Cost-Effectiveness of an Antibacterial Envelope for CIED Infection Prevention in the US Healthcare System from the WRAP-IT Trial.

MedStar author(s):
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
Name of journal: Circulation. Arrhythmia and electrophysiologyAbstract: 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 All authors: Berman BJ, Boriani G, Collier J, Corey R, Cronin EM, Eldadah Z, Evonich RF, Gallastegui JL, Holbrook RW, Kennergren C, Khan HH, Krahn AD, Lande JD, Lexcen DR, Mittal S, Pickett RA, Poole JE, Riggio DW, Roark SF, Schloss EJ, Seshadri S, Sholevar DP, Silver MT, Sorrentino DM, Tarakji KG, Wilkoff BLOriginally published: Circulation: Arrhythmia and Electrophysiology. 2020 Sep 11Fiscal year: FY2021Original title: Cost-Effectiveness of an Antibacterial Envelope for Cardiac Implantable Electronic Device Infection Prevention in the US Healthcare System From the WRAP-IT Trial.Digital Object Identifier: Date added to catalog: 2020-10-06
Holdings
Item type Current library Collection Call number Status Date due Barcode
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

Powered by Koha