(P113) COST-EFFECTIVENESS OF AN INTRAOPERATIVE ANTIBACTERIAL ENVELOPE IN PREVENTING CARDIAC IMPLANTABLE ELECTRONIC DEVICE ASSOCIATED INFECTIONS: A SYSTEMATIC REVIEW

Background: Infection is a major complication following surgery for cardiac implantable electronic devices (CIEDs), and associated with significant patient morbidity and mortality. A large randomized control trial demonstrated that an intraoperative antibacterial envelope used at time of implantation significantly reduces the risk of CIED infection. Given the high costs associated the use of the antimicrobial envelope, the objective of this systematic review was to synthesize the published economic literature on the cost-effectiveness of the antibacterial envelope compared to usual care.

METHODS AND RESULTS: We conducted a systematic electronic search of available economic evaluations from inception to June 2023 using the following databases: MEDLINE (1946-), EMBASE (Excerpta Medica Database 1974-), the Cochrane Library, and the UK National Health Services Economic Evaluation Database. We included economic evaluations (i.e. cost-utility, cost-effectiveness, cost-benefit studies) comparing the antibacterial envelope compared with standard of care in preventing CIED infection. Reviewers screened articles and abstracted data independently and in duplicate. We assessed study quality by appraising methodology using Consensus of Health Economic Criteria.

Of 104 unique citations, 6 studies met the inclusion criteria for qualitative synthesis. All cost-effectiveness studies were conducted from the health care payer perspective in US, Canada, and Western Europe. The estimated value proposition of the antimicrobial envelope compared to standard of care was variable. Half of the included economic studies (N=3) reported additional health benefits (reduced infection and increased quality-adjusted life expectancy) for increased costs at accepted societal thresholds for good value in health care (Table). Cost effectiveness of the antimicrobial envelope was highly dependent on the base infection risk and assumptions regarding the effect on mortality. That is, the value proposition of the antibacterial envelope improved as base infection rates increased. At base infection rates exceeding 6%, the envelope was associated with a cost savings.

Conclusion: There is limited economic literature on the cost-effectiveness of intraoperative antibacterial envelope in preventing CIED infections. Despite substantial variability in the economic modelling and results of included studies, the weight of the evidence suggests that intraoperative use of an antimicrobial envelope may potentially be economically attractive compared to usual care at current device pricing, particularly when the base infection risk is high.