Key result
Universal antibiotic-eluting envelope use for CIED procedures in heart failure is not cost-effective (ICER $112,000/QALY), but use in generator replacements is favorable (ICER $54,000/QALY).
Why the study?
Use of an antibiotic-eluting envelope during cardiac implantable electronic device procedures reduces infection risk but increases procedural costs, leaving its cost-effectiveness in patients with heart failure uncertain.
Is the use of an antibiotic-eluting envelope cost-effective compared to usual care in heart failure patients undergoing cardiac implantable electronic device procedures?
Is the use of an antibiotic-eluting envelope cost-effective compared to usual care in heart failure patients undergoing cardiac implantable electronic device procedures?
Answers are grounded in this paper and cite their sources.
Universal use of antibiotic-eluting envelopes for CIED procedures in heart failure patients is unlikely to be cost-effective for initial implants but is likely cost-effective for higher-risk generator replacements.
BACKGROUND: Use of an antibiotic-eluting envelope (AEE) during cardiac implantable electronic device procedures reduces infection risk but increases procedural costs. We aim to estimate the cost-effectiveness of AEE use during cardiac implantable electronic device procedures among patients with heart failure. METHODS: A state-transition cohort model of heart failure patients undergoing cardiac implantable electronic device implantation or generator replacement was developed with input parameters estimated from randomized trials, registries, surveys, and claims data. Effectiveness was estimated from the World-Wide Randomized Antibiotic Envelope Infection Prevention Trial. AEE was assumed to cost $953 per unit. The model projected mortality, quality-adjusted life-years, costs, and the incremental cost-effectiveness ratio of AEE use compared with usual care from a US healthcare sector perspective over a lifetime horizon. We assumed a cost-effectiveness threshold of $100 000 per quality-adjusted life-year gained. RESULTS: Compared with usual care, AEE use in initial implantations produced an incremental cost-effectiveness ratio of $112 000 per quality-adjusted life-year gained (39% probability of being cost-effective). In generator replacement procedures, AEE use produced an incremental cost-effectiveness ratio of $54 000 per quality-adjusted life-year gained (84% probability of being cost-effective). Results were sensitive to the underlying rate of infection, cost of the AEE, and durability of AEE effectiveness. CONCLUSIONS: Universal AEE use for cardiac implantable electronic device procedures in patients with heart failure with reduced ejection fraction is unlikely to be cost-effective, reinforcing the need for individualized risk assessment to guide uptake of the AEE in clinical practice. Selective use in patients at increased risk of infection, such as those undergoing generator replacement procedures, is more likely to meet health system value benchmarks.
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Modi et al. (2022) studied Heart failure. Antibiotic-eluting envelope vs. Usual care was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained (ICER $112,000 per QALY gained (initial) and $54,000 per QALY gained (replacement)). Universal antibiotic-eluting envelope use for CIED procedures in heart failure is not cost-effective (ICER $112,000/QALY), but use in generator replacements is favorable (ICER $54,000/QALY).
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