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

 -  2020 
<br/><br/>Available online from MWHC library: 2008 - present 
<br/><br/> 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  
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1941-3084 
<br/><br/><label>Standard No.: </label>10.1161/CIRCEP.120.008503 [doi] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Anti-Bacterial Agents/ec [Economics]<br/>*Antibiotic Prophylaxis/ec [Economics]<br/>*Cardiac Resynchronization Therapy Devices/ec [Economics]<br/>*Defibrillators, Implantable/ec [Economics]<br/>*Drug Costs<br/>*Prosthesis Implantation/ec [Economics]<br/>*Prosthesis-Related Infections/ec [Economics]<br/>Absorbable Implants/ec [Economics]<br/>Anti-Bacterial Agents/tu [Therapeutic Use]<br/>Cardiac Resynchronization Therapy Devices/ae [Adverse Effects]<br/>Clinical Decision-Making<br/>Cost Savings<br/>Cost-Benefit Analysis<br/>Decision Trees<br/>Defibrillators, Implantable/ae [Adverse Effects]<br/>Humans<br/>Models, Economic<br/>Multicenter Studies as Topic<br/>Prosthesis Implantation/ae [Adverse Effects]<br/>Prosthesis Implantation/is [Instrumentation]<br/>Prosthesis-Related Infections/mi [Microbiology]<br/>Prosthesis-Related Infections/pc [Prevention & Control]<br/>Quality of Life<br/>Quality-Adjusted Life Years<br/>Randomized Controlled Trials as Topic<br/>Risk Factors<br/>Time Factors<br/>Treatment Outcome<br/>United States
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article