Cost-Effectiveness of an Antibacterial Envelope in Patients at High Risk of Cardiac Implantable Electronic Device...

The Worldwide Randomized Antibiotic Envelope Infection Prevention Trial (WRAP-IT) demonstrated a 40% reduction of major cardiac implantable electronic device (CIED) infection with the use of an absorbable antibacterial envelope in patients at high risk of infection. The objective of this analysis was to determine the cost-effectiveness of this envelope in a high-risk patient population treated in the Australian public healthcare system.

A decision tree model compared the use of an antibacterial envelope versus no envelope over the lifetime of a patient with a high risk of infection as defined in WRAP-IT. Detailed clinical outcomes were based on 12-month data from WRAP-IT and other local inputs derived from local sources including linked-administrative data in New South Wales (NSW).

The use of an antibacterial envelope results in a cost saving of A$157 at 12 months and an incremental cost of A$62 over a lifetime. Incremental quality-adjusted life-years (QALYs) with the envelope were 0.00144 at 12 months and 0.00872 over a lifetime. Both the 12 month and the lifetime cost/QALY gained resulted in an ICER that was "dominant." That is, the envelope did not result in a significant increased cost over a lifetime; however, it resulted in increased QALYs.

An antibacterial envelope is a dominant strategy in patients at high risk of infection. Use of the envelope was essentially cost neutral to the Australian public healthcare system, and increases the quality and length of life of the patient.