TY - JOUR
T1 - Cost-effectiveness of TYRX absorbable antibacterial envelope for prevention of cardiovascular implantable electronic device infection
AU - Kay, Gemma
AU - Eby, Elizabeth L.
AU - Brown, Benedict
AU - Lyon, Julie
AU - Eggington, Simon
AU - Kumar, Gayathri
AU - Fenwick, Elisabeth
AU - Sohail, M. Rizwan
AU - Wright, David Jay
N1 - Funding Information:
Funding for the analysis and publication charges for this article was provided by Medtronic.
Funding Information:
MRS has received honoraria/consulting fees from Medtronic, Spectranetics, and Boston Scientific (all less than US$10K) and a research grant from Medtronic. DJW has received honoraria from Boston Scientific, Medtronic, and St. Jude Medical and a research grant from Boston Scientific for an investigator initiated study. ELE, BB, and SE are employees of Medtronic. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Publisher Copyright:
© 2017 Informa UK Limited, trading as Taylor & Francis Group.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/3/4
Y1 - 2018/3/4
N2 - Aims: Infection is a major complication of cardiovascular implantable electronic device (CIED) therapy that usually requires device extraction and is associated with increased morbidity and mortality. The TYRX Antibacterial Envelope is a polypropylene mesh that stabilizes the CIED and elutes minocycline and rifampin to reduce the risk of post-operative infection. Methods: A decision tree was developed to assess the cost-effectiveness of TYRX vs standard of care (SOC) following implantation of four CIED device types. The model was parameterized for a UK National Health Service perspective. Probabilities were derived from the literature. Resource use included drug acquisition and administration, hospitalization, adverse events, device extraction, and replacement. Incremental cost-effectiveness ratios (ICERs) were calculated from costs and quality-adjusted life-years (QALYs). Results: Over a 12-month time horizon, TYRX was less costly and more effective than SOC when utilized in patients with an ICD or CRT-D. TYRX was associated with ICERs of £46,548 and £21,768 per QALY gained in patients with an IPG or CRT-P, respectively. TYRX was cost-effective at a £30,000 threshold at baseline probabilities of infection exceeding 1.65% (CRT-D), 1.95% (CRT-P), 1.87% (IPG), and 1.38% (ICD). Limitations and conclusions: Device-specific infection rates for high-risk patients were not available in the literature and not used in this analysis, potentially under-estimating the impact of TYRX in certain devices. Nevertheless, TYRX is associated with a reduction in post-operative infection risk relative to SOC, resulting in reduced healthcare resource utilization at an initial cost. The ICERs are below the accepted willingness-to-pay thresholds used by UK decision-makers. TYRX, therefore, represents a cost-effective prevention option for CIED patients at high-risk of post-operative infection.
AB - Aims: Infection is a major complication of cardiovascular implantable electronic device (CIED) therapy that usually requires device extraction and is associated with increased morbidity and mortality. The TYRX Antibacterial Envelope is a polypropylene mesh that stabilizes the CIED and elutes minocycline and rifampin to reduce the risk of post-operative infection. Methods: A decision tree was developed to assess the cost-effectiveness of TYRX vs standard of care (SOC) following implantation of four CIED device types. The model was parameterized for a UK National Health Service perspective. Probabilities were derived from the literature. Resource use included drug acquisition and administration, hospitalization, adverse events, device extraction, and replacement. Incremental cost-effectiveness ratios (ICERs) were calculated from costs and quality-adjusted life-years (QALYs). Results: Over a 12-month time horizon, TYRX was less costly and more effective than SOC when utilized in patients with an ICD or CRT-D. TYRX was associated with ICERs of £46,548 and £21,768 per QALY gained in patients with an IPG or CRT-P, respectively. TYRX was cost-effective at a £30,000 threshold at baseline probabilities of infection exceeding 1.65% (CRT-D), 1.95% (CRT-P), 1.87% (IPG), and 1.38% (ICD). Limitations and conclusions: Device-specific infection rates for high-risk patients were not available in the literature and not used in this analysis, potentially under-estimating the impact of TYRX in certain devices. Nevertheless, TYRX is associated with a reduction in post-operative infection risk relative to SOC, resulting in reduced healthcare resource utilization at an initial cost. The ICERs are below the accepted willingness-to-pay thresholds used by UK decision-makers. TYRX, therefore, represents a cost-effective prevention option for CIED patients at high-risk of post-operative infection.
KW - Cost-effectiveness
KW - antibacterial envelope
KW - cardiovascular implantable electronic device
KW - infection
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U2 - 10.1080/13696998.2017.1409227
DO - 10.1080/13696998.2017.1409227
M3 - Article
AN - SCOPUS:85040996712
VL - 21
SP - 294
EP - 300
JO - Journal of Medical Economics
JF - Journal of Medical Economics
SN - 1369-6998
IS - 3
ER -