Cost-effectiveness of Antibacterial Envelope for Sacral Neuromodulation Infection Prevention

Area of Science:

• Urology
• Health Economics
• Infectious Disease Prevention

Background:

• Sacral neuromodulation (SNM) infections lead to significant patient morbidity, device explantation, and increased healthcare costs.
• Antibiotic-impregnated envelopes may reduce SNM infection risk, but their cost-effectiveness requires evaluation.

Purpose of the Study:

• To determine the cost-effectiveness of universal versus selective (salvage) antibiotic envelope use for preventing SNM implantation infections.
• To compare three strategies: no envelope, salvage use, and universal use.

Main Methods:

• A Monte Carlo cost-effectiveness analysis with 10,000 iterations using a decision-analytic Markov model.
• Comparison of three strategies from a third-party payer perspective over a 3-year horizon.
• Application of a $100,000 per quality-adjusted life year willingness-to-pay threshold and sensitivity analyses.

Main Results:

• Salvage envelope use demonstrated cost-effectiveness, preventing one infection per 186 implants with a 0.54% infection reduction.
• Universal use became cost-effective with a 1.58% infection reduction or a price decrease of $42.47.
• Probabilistic sensitivity analysis favored salvage use (55.2%) over universal use (44.8%), with the 'no envelope' strategy rarely preferred.

Conclusions:

• Selective antibiotic envelope use during SNM reimplantation is currently cost-effective.
• Universal use may become cost-effective with enhanced infection prevention or reduced pricing.
• Findings support data-driven envelope application and can inform clinical guidelines and pricing policies.