OBJECTIVES

Use of an absorbable antibacterial envelope reduces cardiac implantable electronic device (CIED) infection in patients undergoing implantation, revision, replacement or upgrade. The risk of infection during these procedures is estimated from 1-4% and increases for patients with high-risk factors. We evaluated the cost-effectiveness of the antibacterial envelope in Mexican public institutes in high-risk patients.

METHODS

A decision tree model was used to compare costs and outcomes of the antibacterial envelope used adjunctive to standard-of-care infection prevention versus standard-of-care alone over the short term in high-risk patients, from a public payor perspective.

Baseline infection rates were taken from Mexican literature and adjusted to reflect high-risk; it was assumed that all patients were undergoing reintervention. Antibacterial envelope effectiveness for the high-risk patient population was used; high-risk patients were defined as those with ≥2 risk-factors. Treatment costs were obtained from public sector GRDs and unitary costs.

Results were based on cost per reduction point in infection. An upper willingness-to-pay threshold of 1 GDP per capita was used to determine cost-effectiveness.

RESULTS

The base case results showed that the antibacterial envelope was dominant compared with standard-of-care. The antibacterial envelope remained dominant at the willingness-to-pay threshold in 64% of iterations in the probabilistic sensitivity analysis, and was sensitive to the following model inputs: infection rate and cost of the envelope.

CONCLUSIONS

The antibacterial envelope was dominant in the high-risk patient population in Mexico. This suggests that the envelope provides value for the Mexican healthcare system by reducing the incidence of cardiac implantable electronic device infection and its associated mortality and morbidity, in a highly prevalent population.