Policy, Payment & Practice -> Health Economics D-PO05 - Poster Session V (ID 39) Poster


Background: The WRAP-IT study found that adjunctive use of an antibacterial envelope (TYRX) resulted in a 40% reduction of major CIED infection without increased risk of complication in 6983 patients undergoing CIED revision, replacement, upgrade or initial CRT-D implant. There is limited information on the cost-effectiveness of this strategy in the US healthcare system.
Objective: As a pre-specified objective of the WRAP-IT study, we evaluated the cost-effectiveness of the envelope compared to standard-of-care infection prevention strategies from the perspective of an integrated payer-provider network in the US healthcare system.
Methods: We adapted a published decision tree model to compare costs and outcomes of envelope use versus standard-of-care over a lifetime time horizon. Baseline infection rates, envelope effectiveness, costs, infection-related mortality, and utility estimates were obtained from the WRAP-IT study. Life expectancy and long-term costs associated with device replacement, follow-up, and heart failure hospitalizations were sourced from the literature. Costs and quality-adjusted life years (QALYs) were discounted at 3%. An upper willingness-to-pay (WTP) threshold of $150,000 per QALY was used to determine cost-effectiveness, in alignment with ACC/AHA practice guidelines on Cost/Value Methodology and 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 $112,731/QALY. The probabilistic sensitivity analysis found that the ICER remained lower than the WTP threshold in 74% of iterations. The ICER was most sensitive to the following model inputs: infection-related mortality, life expectancy, infection cost, quality of life, lifetime costs, and probability of device extraction.
Conclusion: Adjunctive use of the TYRX envelope significantly reduces the incidence of CIED infection without increased risk of complication. The TYRX envelope is cost-effective for the WRAP-IT study population from the perspective of an integrated payer-provider network in the US.