Economic impact of introducing TYRX amongst patients with heart failure and reduced ejection fraction undergoing implanted cardiac device procedures: a retrospective model based cost analysis

Abstract

Background and Aims: Infection is a serious and expensive complication of Cardiac Implantable Electronic Device (CIED) procedures. We performed a retrospective based cost analysis to estimate Trust level savings of using the TYRX TM antibacterial envelope as a primary prevention measure against infection in a tertiary referral centre in South London, United Kingdom. Methods: A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures were evaluated. Decision-analytic modelling was performed to determine economic savings of using the envelope during CIED procedure versus CIED procedure alone. Results: Over a 12 month follow-up period following CIED procedure the observed infection rate was 3.14% (n=5/159). The average cost of a CIED infection inpatient admission was £41,820 and further to economic analysis, the additional costs attributable to infection was calculated at £62,213.94. A cost saving of £624 per patient by using TYRX TM during CIED procedure as a primary preventative measure against infection was estimated. Conclusions: TYRX™ would be a cost-saving treatment option amongst heart failure patients undergoing ICD and CRT device procedures based on analysis in the local geographical area of South London. If upscaled to the UK population, we estimate potential cost savings for the

Cost-Effectiveness Analyses of an Absorbable Antibacterial Envelope for Use in Patients at Increased Risk of Cardiac Implantable Electronic Device Infection in Germany, Italy, and England

“…The total costs of treating CIED infection in the current model, which were calculated based on resource use data from WRAP-IT, were comparable to those previously reported in Germany (V31 493-V33 777 vs V23 429-V42 921 in the current model) 7 and in England (£14 241-£41 820 vs £14 466-£37 633 in the current model). 6,[8][9][10] Differences can be explained in part by differing resource use associated with CIED infection compared to the current model. If real-world costs of CIED infection are higher than those applied in the model, the envelope is likely to be more costeffective.…”

“…5 Studies conducted in the English population of CIED recipients have reported overall infection rates of 0.6%-1.3% 6 and 3.14% (CRT and ICD only). 8 A worldwide systematic review and meta-analysis reported a CIED infection rate of 1% to 1.3% overall, with substantially higher rates among high-risk patients (eg, odds ratios of infection of 1.9 for device replacements/revisions and 7.84 in patients who had a previous CIED infection). 12 Infection rates may be underestimated in large RCTs, partly due to the Hawthorne effect (where healthcare staff and patients modify their behavior because they are being observed) leading to provision of better care in the trial setting.…”

“…[5][6][7][8][9][10][11] The incidence of CIED infections is estimated between 1% and 4% of CIED recipients. [5][6][7][8][12][13][14] In part due to the rising prevalence of certain risk factors among CIED recipients, the rate of CIED infection is reported to be increasing in excess of the implantation rate. 15 An infection risk score was developed from the Prevention of Arrhythmia Device Infection Trial (PADIT), as shown in the Supplemental Materials found at https://doi.org/10.1016/j.jval.202 0.12.021.…”

A systematic approach towards implementing value-based health care in heart failure: Understandings from retrospective analysis methods in South London

“…Our, now purpose built database allows for systematic approach to analysis, which can determine both health service related and patient related outcomes for a said independent variable or intervention, as exampled in Table 8.Our group has recently published work using this database on a said intervention and its outcomes on CIED infection related healthcare costs confirming its functionality. 7 As previously mentioned, the limitation in our small cohort does not allow for meaningful statistical analysis, however, if the population was upscaled nationally or widened to include all heart failure populations, our automated system would be able to produce data that could guide CCG decisions on NHS expenditure.…”

Financial and resource costs of transvenous lead extraction in a high-volume lead extraction centre

“…Furthermore, the The Worldwide Randomized Antibiotic Envelope Infection Prevention Trial (WRAP-IT) reported significantly lower incidences of infection using antibiotic envelopes compared with standard of care 22. Burnhope et al 23 performed retrospective cost analyses of the antibiotic envelope in the heart failure population and identified an estimated cost saving of £624 per patient. Such strategies should be used as an adjunct to preprocedure intravenous antibiotics, strict aseptic technique and good surgical technique with careful haemostasis for all CIED procedures.…”