Cost-Effectiveness of Antibiotic-Eluting Envelope for Prevention of Cardiac Implantable Electronic Device Infections in Heart Failure.
Cost-Effectiveness of Antibiotic-Eluting Envelope for Prevention of Cardiac Implantable Electronic Device Infections in Heart Failure.
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抗生素洗脱包膜预防心力衰竭心脏植入电子设备感染的成本效益。
DOI：
10.1161/circoutcomes.121.008443
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Kazi,DhruvS
中科院分区：
文献类型：
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作者：
Modi,RonukM;Liu,Chia-Liang;Isaza,Nicolas;Raber,Inbar;Calvachi,Paola;Zimetbaum,Peter;Bellows,BrandonK;Kramer,DanielB;Kazi,DhruvS
背景在心脏植入式电子设备手术中使用药物洗脱包膜（AEE）降低了感染风险，但增加了手术成本。我们的目的是估计AEE使用的成本效益，在心脏植入式电子设备程序中的患者heartful.MethodsA状态转换队列模型的心力衰竭患者进行心脏植入式电子设备植入或发电机更换的输入参数估计随机试验，登记，调查和索赔数据。根据全球随机抗生素包膜感染预防试验估计有效性。假设AEE的成本为953/单位。模型预测的死亡率，质量调整生命年，成本，和增量成本-效果比的AEE使用相比，通常的护理美国健康护理的角度来看，在整个生命时间范围。我们假设成本-效果阈值为100 000/质量调整生命年获得。结果与通常的护理相比，AEE在初始预防中的使用产生了112000/质量调整寿命年的增量成本效益比（39%的可能性是成本有效的）。新生儿预防程序，使用AEE产生的增量成本-效果比为54000/质量调整生命年（84%的可能性是成本有效的）。结果是敏感的潜在感染率，成本的AEE，和持久性的AEE effectiveness.ConclusionsUniversal AEE使用心脏植入式电子设备程序的心脏衰竭患者射血分数降低是不可能的成本效益，加强需要个性化的风险评估，以指导摄取的AEE在临床实践中。在感染风险增加的患者中选择性使用，例如那些接受发生器更换手术的患者，更有可能达到卫生系统的价值基准。
BackgroundUse of an antibiotic-eluting envelope (AEE) during cardiac implantable electronic device procedures reduces infection risk but increases procedural costs. We aim to estimate the cost-effectiveness of AEE use during cardiac implantable electronic device procedures among patients with heart failure.MethodsA state-transition cohort model of heart failure patients undergoing cardiac implantable electronic device implantation or generator replacement was developed with input parameters estimated from randomized trials, registries, surveys, and claims data. Effectiveness was estimated from the World-Wide Randomized Antibiotic Envelope Infection Prevention Trial. AEE was assumed to cost 953perunit.Themodelprojectedmortality,quality-adjustedlife-years,costs,andtheincrementalcost-effectivenessratioofAEEusecomparedwithusualcarefromaUShealthcaresectorperspectiveoveralifetimehorizon.Weassumedacost-effectivenessthresholdof 100 000 per quality-adjusted life-year gained.ResultsCompared with usual care, AEE use in initial implantations produced an incremental cost-effectiveness ratio of 112000perquality-adjustedlife-yeargained(39%probabilityofbeingcost-effective).Ingeneratorreplacementprocedures,AEEuseproducedanincrementalcost-effectivenessratioof 54 000 per quality-adjusted life-year gained (84% probability of being cost-effective). Results were sensitive to the underlying rate of infection, cost of the AEE, and durability of AEE effectiveness.ConclusionsUniversal AEE use for cardiac implantable electronic device procedures in patients with heart failure with reduced ejection fraction is unlikely to be cost-effective, reinforcing the need for individualized risk assessment to guide uptake of the AEE in clinical practice. Selective use in patients at increased risk of infection, such as those undergoing generator replacement procedures, is more likely to meet health system value benchmarks.